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Thorax 58:470-483 doi:10.1136/thorax.58.6.470
  • BTS guidelines

British Thoracic Society guidelines for the management of suspected acute pulmonary embolism

  1. British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group*
  1. Correspondence to:
    Dr A C Miller, Mayday Hospital, Croydon CR7 7YE, UK;
    andrew.miller{at}mayday.nhs.uk

    INTRODUCTION

    In 1997 the British Thoracic Society (BTS) published advice entitled “Suspected acute pulmonary embolism: a practical approach”.1 It was recognised that it would need updating within a few years. Subsequent publications in several areas (CT pulmonary angiography, d-dimer, clinical probability, low molecular weight heparin) now provide sufficient evidence to allow this advice to be updated as guidelines.

    All the relevant literature published from January 1997 to December 2002 was located by searching the Medline and EmBase databases; some were meta-analyses and some were evidence based practice guidelines. Relevant papers published before 1997 not referenced in the earlier document were also retrieved.

    As before, the text was compiled by members of the BTS on behalf of its Standards of Care Committee, with feedback from experts recommended by specialist societies and, as with the previous guideline, we approached international authorities who all readily agreed to comment on the drafts. We are indebted to these advisors.

    These guidelines supersede the 1997 document, but many of the earlier concepts remain relevant. Where allusions are made to the previous document, this is shown as the page number in curly brackets {S18}. Papers from that document are not cited in the reference list, which therefore refers almost exclusively to publications from 1997 onwards. A similar structure to that in the previous guideline has been used, comprising a reference section, summary of recommendations, and a practical section for junior doctors.

    It was decided that the updated guidelines would concentrate on suspected pulmonary embolism (PE) and only include deep vein thrombosis (DVT) where relevant, even though both are part of venous thromboembolism (VTE). Compared with DVT alone, PE is potentially more serious and has a differential diagnosis of other serious conditions; many hospitals have established local protocols for the diagnosis and treatment of DVT but not …

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