Pulmonary Embolism Index of Suspicion: Adding Data to Gestalt

Acute pulmonary embolism (PE), especially when not immediately life-threatening, is not always readily recognized at presentation. Though the pathophysiology of ventilation-perfusion mismatch is consistent, clinical manifestations vary and may be relatively subtle. The consequences of delayed diagnosis and management may be severe. We review the basis and utility of four validated decision rules for excluding pulmonary embolism and emphasize the inescapable component of evaluation that requires clinician impression or “gestalt” in the assessment of “Is PE the most likely diagnosis that explains this presentation”?