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[Diagnostic strategy in pulmonary embolism. National French survey].

OBJECTIVE
Since the clinical expression of pulmonary edema (PE) is neither sensitive nor specific, its diagnosis relies on several complementary examinations that are interpreted according to the clinical probability of the disease. Various non-invasive examinations now complete the standard policy. Our aim was to study their use in practice.


METHOD
We sent a postal survey to 199 french metropolitan hospital departments of cardiology or pneumology and sent a reminder two months later.


RESULTS
We obtained replies from 94 departments, divided among 22 university hospitals, 52 departments of cardiology and 27 departments of pneumology. Among these departments, 87% had a PE diagnosis strategy depending on clinical suspicion. However, only 34% used different examination sequences depending on whether suspicion was strong or weak. The complementary examinations were helical computed thoracic tomography in 64% of cases, pulmonary angiography in 42% and ventilation-perfusion scintigraphy in 23%.


DISCUSSION
The response rates were the same, whatever the department surveyed. Other than the more frequent use of cardiac sonography by cardiologists, there was no significant qualitative difference between the diagnosis strategies of the departments of cardiology and pneumology. The examination most frequently used at the end of the diagnostic proceeding was thoracic angiographic scan, although its diagnostic efficacy remains insufficient. With regard to international recommendations, pulmonary angiography is underused.