Multiorgan POCUS to rule out P.E.

Diagnosing pulmonary embolism (PE) in the emergency department remains a significant challenge. Deciding on who to scan, who to anticoagulate, and who to discharge home can be difficult. This recent article by Nazerian, et al, in Chest may allow a way for POCUS to significantly rule out PE in a large number of patients.

They used multiorgan POCUS (lung, cardiac, legs) on 510 adult patients presenting to the ED with suspected P.E. Those with a negative D-dimer and low Wells score were excluded. Of the 357 patients remaining, Multiorgan POCUS was compared to CT to determine sensitivity, specificity and likelihood ratios to diagnose PE. Ultrasound was considered diagnostic if any one of the following was positive: subpleural infarct on lung ultrasound, RV dilatation, DVT on compression ultrasound. If any alternate diagnosis was discovered on POCUS, this was recorded.

Results were quite impressive: Sensitivity, specificity, LR+, and LR- of multi organ POCUS were 90%, 86.2%, 6.5, and 0.12, respectively. Even more impressive was if multiorgan POCUS was negative AND an alternate diagnosis was found on POCUS: Sensitivity, and LR- were 100% and 0, effectively ruling out PE in their patients.

While this study certainly merits repeating, it reveals how POCUS may be used to rapidly rule out P.E. in your patient with dyspnea suggestive of a P.E.