Suspected Acute Pulmonary Embolism: Gestalt, Scoring Systems, and Artificial Intelligence

Abstract

Pulmonary embolism (PE) remains a diagnostic challenge in 2021. As the pathology is potentially fatal and signs and symptoms are nonspecific, further investigations are classically required. Based on the Bayesian approach, clinical probability became the keystone of the diagnostic strategy to rule out PE in the case of a negative testing. Several clinical probability assessment methods are validated: gestalt, the Wells score, or the revised Geneva score. While the debate persists as to the best way to assess clinical probability, its assessment allows for the good interpretation of the investigation results and therefore directs the correct diagnostic strategy. The wide availability of computed tomography pulmonary angiography (CTPA) resulted in a major increase in investigations with a moderate increase in diagnosis, without any notable improvement in patient outcomes. This leads to a new challenge for PE diagnosis which is the limitation of the number of testing for suspected PE. We review different strategies recently developed to achieve this goal. The last challenge concerns the implementation in clinical practice. Two approaches are developed: simplification of the strategies versus the use of digital support tools allowing more sophisticated strategies. Artificial intelligence with machine-learning algorithms will probably be a future tool to guide the physician in this complex approach concerning acute PE suspicion.

Predictive Value of MPV and Plasma NT-ProBNP Combined with the Simplified Geneva Scale for the Prognosis of Acute Pulmonary Embolism

“…The simplified Geneva scale is a scoring method for judging the risk of thrombosis. The scoring includes items such as advanced age, medical history, fracture, heart rate, and so on [ 22 ]. It is objective, comprehensive, and repeatable and does not require excessive reliance on objective examinations, which helps evaluate the prognosis of APE patients [ 23 ].…”

Pulmonary embolism and hemorrhage after displacement of angiographic catheter tip to pulmonary artery: A case report and literature review

“…According to the pulmonary embolism risk score, the D2-polymer fluctuated between 1236 and 8496 μg/L after thrombolysis, and the patient had symptoms of hemoptysis and was older than 65 years [ 20 , 21 ]. Therefore, the Revised Geneva system score was 6 points, and the probability of recurrent pulmonary embolism was more than 40 % [ 22 ]. In this case, no embolus was found in the pulmonary artery CTA 2 days after surgery, but enhanced chest CT indicated ground glass shadows and rope shadows in the middle lobe of the right lung and lower lobe of both lungs and fan-shaped consolidation in the lower lobe of the right lung.…”

A machine learning model for diagnosing acute pulmonary embolism and comparison with Wells score, revised Geneva score, and Years algorithm

“…Many previous studies have appreciated the importance of clinical assessment in the diagnosis of APE [8,[13][14][15] ; however, a standard assessment criterion is currently lacking. Notably, using clinical assessment to its full potential could help in the safe exclusion of APE without the need for CTPA examination.…”