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August 07, 2007
Pulmonary Embolism
A blood clot to the lung will kill you. Well, maybe 10% of the time. ACEP (American College of Emergency Physicians) and others are back on the push not to miss any. And that is a good push, since many lawsuits arise out of this very failure to diagnose. But many of the deaths from a PE are within one hour, and probably couldn't be prevented.
So we are told we miss 400,000 of these a year. Only 100,000 of these are preventable by quick diagnosis and treatment. (Presumably this is mostly the 30% who die with a recurrent clot.)
The symptoms for a PE are frequently misleading and vague. There is no perfect test for a PE. Some are better at ruling against, some better at ruling for, but none are good at both. So we are to test the tens of millions of people who present to an ER with these vague symptoms, in the hopes of finding the 400,000 we are missing, and in the hopes that the treatment for these will prevent 100,000 deaths a year.
And at what cost? At what danger to the tens of millions unnecessarily subjecting to sometimes invasive, frequently expensive, and always worrying testing? What of those unnecessarily put on blood thinners, who then develop complications or death from bleeding?
And what of the unnecessary and unproven surgery that put these people at risk in the first place, or the car wreck that put them at this further risk, or the oral contraceptive they shouldn't be using?
Did they die of a PE, or at the hands of a surgeon, or bad driver, or immoral behavior?
| By Robert Maddox | 05:02 PM