As the year draws to a close I will be writing a series of posts on the major issues of the year in the field of hospital medicine. Disclaimer: This list reflects solely the biases of a committee of one (me). The reverse numerical order of posting does not necessarily reflect the order of importance. I have blogged about some, but not all of the issues before.
Issue 10: The diagnosis of pulmonary embolism.
The long awaited results of PIOPED II were announced at the close of last year at the Radiological Society of North America national meeting. There was also some discussion of the results at Chest 2004. To the best of my knowledge the results have not yet been published. Despite hopes that CT would emerge as the clear diagnostic modality of choice the PIOPED II results suggested otherwise: the best approach is individualized, and usually based on the integration of multiple modalities and clinical data. I presented my thoughts on the issue earlier this year. That post has more information on the PIOPED II findings, which will not be repeated here.
I think Gregory S. Martin, speaking about PIOPED II at Chest 2004, sums it up best: Based on these results, the use of PE-protocol CT cannot be advocated as a stand-alone procedure for diagnosing PE.