If a patient presents with signs or symptoms of PE, carry out an assessment of their general medical history, a physical examination and a chest X-ray to exclude other causes.

Relative values of different outcomesThis recommendation helps to ensure that alternative diagnosis or causes of the signs and symptoms are fully investigated and have not been missed
Trade off between clinical benefits and harmsAssessing the general medical history and physical examination does not present any harm to the patient and may pick up or exclude other possible causes for the patient’s symptoms. Completing this step of the diagnosis is crucial, as it will direct the consecutive diagnostic pathway to be undertaken for the patient. Ruling out alternative diagnosis is an item on the two-level PE Wells score. Performing this step correctly is crucial in the appropriate use of the two-level PE Wells Score and pre-test probability scoring.
Economic considerationsThe assessment of the general medical history and the physical examination are associated with some increase in the clinician’s time but they are not expected to increase costs considerably. Chest X-ray is associated with additional costs but they are likely to be offset by the advantages when ruling out other diagnoses and consequently avoiding further more costly tests and radiation exposure.
Quality of evidenceThis is a supporting recommendation and we did not look at the evidence. This recommendation is based on GDG consensus.
Other considerationsChest X-ray could help to detect other conditions such as pneumothorax, consolidation, and pleural effusion.

From: 6, Diagnosis of pulmonary embolism

Cover of Venous Thromboembolic Diseases
Venous Thromboembolic Diseases: The Management of Venous Thromboembolic Diseases and the Role of Thrombophilia Testing [Internet].
NICE Clinical Guidelines, No. 144.
National Clinical Guideline Centre (UK).
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