Pulmonary Emboli in Older Adults

With Dr. Jeff Kline

Christina Shenvi

Not a day goes by that an Emergency Physician doesn’t at least consider PE in a patient who presents with chest pain, dyspnea, or syncope. We have become familiar with using risk stratification tools like the Wells Score and the PERC criteria. But what do you do in older adults? All of them will automatically NOT be PERC negative because of their age. In this episode, with PE guru Jeff Kline, we discuss the presentation of PE in older adults, including the demographics, diagnosis, and how treatment may differ from younger adults in small, sub-massive, and massive PEs.


  1. Zondag W, Vingerhoets LM, Durian MF, et al. Hestia criteria can safely select patients with pulmonary embolism for outpatient treatment irrespective of right ventricular function. J Thromb Haemost. 2013;11(4):686-692. http://www.ncbi.nlm.nih.gov/pubmed/23336721
  2. Beam DM, Kahler ZP, Kline JA. Immediate discharge and home treatment with rivaroxaban of low-risk venous thromboembolism diagnosed in two U.S. emergency departments: A one-year preplanned analysis. Acad Emerg Med. 2015;22(7):788-795. http://www.ncbi.nlm.nih.gov/pubmed/26113241
  3. Kahler ZP, Kline JA. Standardizing the D-dimer assay: Proposing the D-dimer international managed ratio. Clin Chem. 2015;61(5):776-778. http://www.ncbi.nlm.nih.gov/pubmed/25816812
  4. Kahler ZP, Beam DM, Kline JA. Cost of treating venous thromboembolism with heparin and warfarin versus home treatment with rivaroxaban. Acad Emerg Med. 2015;22(7):796-802. http://www.ncbi.nlm.nih.gov/pubmed/26111453
  5. Zhang Y, Zhou Q, Zou Y, et al. Risk factors for pulmonary embolism in patients preliminarily diagnosed with community-acquired pneumonia: A prospective cohort study. J Thromb Thrombolysis. 2015. http://www.ncbi.nlm.nih.gov/pubmed/26370200
  6. Sharp AL, Vinson DR, Alamshaw F, Handler J, Gould MK. An age-adjusted D-dimer threshold for emergency department patients with suspected pulmonary embolus: Accuracy and clinical implications. Ann Emerg Med. 2016;67(2):249-257. http://www.ncbi.nlm.nih.gov/pubmed/26320520
  7. Kirschner JM, Kline JA. Is it time to raise the bar? age-adjusted D-dimer cutoff levels to exclude pulmonary embolism. Ann Emerg Med. 2014;64(1):86-87. http://www.ncbi.nlm.nih.gov/pubmed/24951413
  8. Kline JA, Kabrhel C. Emergency evaluation for pulmonary embolism, part 2: Diagnostic approach. J Emerg Med. 2015;49(1):104-117. http://www.ncbi.nlm.nih.gov/pubmed/25800524
  9. Kline JA, Courtney DM, Kabrhel C, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost. 2008;6(5):772-780. http://www.ncbi.nlm.nih.gov/pubmed/18318689


This podcast uses sounds from freesound.org by Jobro and HerbertBoland.

Image credit.

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Christina Shenvi


Dr. Christina Shenvi is an associate professor of Emergency Medicine at the University of North Carolina. She is fellowship-trained in Geriatric Emergency Medicine and is the founder of GEMCast. She is the director of the UNC Office of Academic Excellence, president of the Association of Professional Women in Medical Sciences, co-directs the ACEP/CORD Teaching Fellowship, is on the Annals of EM editorial board, is on the Geriatric ED Accreditation board of governors, and she teaches and writes about time management at timeforyourlife.org.

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