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Pulmonary Arteriography: The Gold Standard-Reply

Vincent L. Hoellerich, MD; Robert S. Wigton, MD
Arch Intern Med. 1987;147(2):205. doi:10.1001/archinte.1987.00370020025013.
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Dr Sautter questions the proposed application of our decision rule that could limit the use of pulmonary arteriography in some patients with suspected pulmonary embolism (PE).1 He suggests that pulmonary arteriography should be encouraged in this population because it is a "simple procedure" that establishes a "clear... diagnosis."

Certainly we agree that in patients with suspected PE a simple procedure to make the diagnosis should be used appropriately. But does Dr Sautter propose that pulmonary arteriography be performed in every patient in whom a PE is a possibility? Is it not possible that within the patient population in whom there is a clinical suspicion of PE, there exists a subset of patients in whom a PE is either so likely or so unlikely that an arteriogram would not be necessary to make the diagnosis?

In our study populations, we found that not only did there exist such a stratification


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