• Tadeja Hernja Rumpf, Miljenko Krizmaric, and Stefek Grmec.
• University Clinical Centre Maribor, 2000 Maribor, Slovenia. tadeja.rumpf@gmail.com
• Crit Care. 2009 Jan 1;13(6):R196.

IntroductionPulmonary embolism (PE) is one of the greatest diagnostic challenges in prehospital emergency setting. Most patients with suspected PE have a positive D-dimer and undergo diagnostic testing. Excluding PE with additional non-invasive tests would reduce the need for further imaging tests. We aimed to determine the effectiveness of combination of clinical probability and end-tidal carbon dioxide (PetCO2) for evaluation of suspected PE with abnormal concentrations of D-dimer in prehospital emergency setting.MethodsWe assessed clinical probability of PE and PetCO2 measurement in 100 consecutive patients with suspected PE and positive D-dimer in the field. PetCO2 > 28 mmHg was considered as the best cut-off point. PE was excluded or confirmed by hospital physicians in the University Clinical Center Maribor by computer tomography (CT), ventilation/perfusion scan echocardiography and pulmonary angiography.ResultsPE was confirmed in 41 patients. PetCO2 had a sensitivity of 92.6% (95% CI, 79 to 98%), a negative predictive value of 94.2% (95% CI, 83 to 99%), a specificity of 83% (95% CI, 71 to 91%) and a positive predictive value of 79.2% (95% CI, 65 to 89%). Thirty-five patients (35%) had both a low (PE unlikely) clinical probability and a normal PetCO2 (sensitivity: 100%, 95% CI: 89 to 100%) and twenty-eight patients (28%) had both a high clinical probability (PE likely) and abnormal PetCO2 (specificity: 93.2%, 95% CI: 83 to 98%).ConclusionsThe combination of clinical probability and PetCO2 may safely rule out PE in patients with suspected PE and positive D-dimer in the prehospital setting.

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