Pulmonary embolism in hospital practice: View from primary care is chest pain and breathlessness, but not together

doi:10.1136/bmj.332.7536.304-a

BMJ 2006;332:304 (4 February), doi:10.1136/bmj.332.7536.304-a

Letter

Pulmonary embolism in hospital practice

View from primary care is chest pain and breathlessness, but not together

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EDITOR—Robinson describes pulmonary embolism in hospitalpractice.¹ Pleuritic chest pain in primary care is common, usuallywith no other signs. What tests, if any, need to be done inpatients not "ill," to rule out small pulmonary emboli?

Silent breathlessness is also common. What is the best investigation,again from primary care, to exclude a silent pulmonary embolismif a V/Q scan is now obsolete and trying to get any activityrelated to computed tomography in a reasonable time scale notpossible?

I write as a general practitioner who has seen four or fivesilent pulmonary embolisms over the years (suggested by outpatientV/Q scans) and two deaths from missed emboli that recurred orextended. If it is a d-dimer test, what can be taken as a valuebelow which the risks are minimal?

John Sharvill, general practitioner

Deal, Kent CT14 7AU john.sharvill@nhs.net

Competing interests: None declared.