PIOPED

• Interperative Criteria
• Patient Selection
• Prevalence of PE in PIOPED Patients
• Reader Agreement
• Prior Probability Estimates by PIOPED Investigators
• Results
• Fraction of PE in Each Lung Scan Catagory
• Causes of V/Q Mismatch
• Gestalt Results
• Posterior Probability of Disease

Health Care Policy

• Pulmonary Embolism has a High Mortality
• NIH Consensus Development Conference on PE Rx
• Conservative Therapy for DVT
• Good Outcome of Low Probability Lung Scans
• Dilema

Severity of Pulmonary Embolism

• Quotation about PE Severity
• Methods of PE Diagnosis
• Methods of Measuring PE Severity

Lung Scintigraphy

• Traditional Interpretation
• Inclusion of Severity

Decision Analysis

• Do a Lung Scan?
• Diagnostic Algorithm Thesis: Utility is a Function of Severity
• Utility of Therapy as a Function of DIsease Severity
• PE Prob vesus Severity
• Calculation of Utility of Therapy
• Therapeutic Choices
• Outcomes
• Decision Tree with Therapy and Outcomes
• Effect of a Test
• Utilities of Various Therapies
• Decision Threshold

Problems

Can We Measure Severity?

• PESeverityMeasures.GIF
• PESeverityMeasureDelta.GIF

Is Outcome a Function of Severity?

• UPET
• Alpert, PBBH

Pulmonary Embolism and Deep Venous Thrombosis

• Pulmonary Ebolism in DVT
  • Kistner
  • Moser
  • Dorfman
• Calf versus Thigh
  • Moser
  • Dorfman
• Symptomatic versus Asymptomatic
  • Kistner
  • Moser

PE Incidence After Orthopedic Surgery

Echocardiography

• Right Ventricular Strain Raises Posibility of PE
• Sensitivity