What are the Scarbossa criteria used for in diagnosing pulmonary embolism?

Scarbossa Criteria Are Not Used for Diagnosing Pulmonary Embolism

The Scarbossa criteria are electrocardiographic criteria used to diagnose acute myocardial infarction in the presence of left bundle branch block (LBBB) or ventricular pacing—they have no role in pulmonary embolism diagnosis.

What Scarbossa Criteria Actually Diagnose

The question appears to contain a fundamental misunderstanding. Scarbossa criteria are a set of ECG findings specifically developed to identify acute MI when LBBB obscures the typical ST-segment changes. They are completely unrelated to pulmonary embolism diagnosis.

Actual Diagnostic Approach for Pulmonary Embolism

Clinical Probability Assessment

For patients with suspected PE, the diagnostic strategy should be based on clinical probability assessment using either clinical judgment or validated prediction rules such as the Wells score or revised Geneva score 1.

• The revised Geneva score includes: previous PE/DVT, heart rate (75-94 or ≥95 bpm), recent surgery/fracture, hemoptysis, active cancer, unilateral lower-limb pain, pain on deep venous palpation with unilateral edema, and age >65 years 1
• Clinical probability categorizes patients into low (10% PE prevalence), intermediate (30%), or high (~65%) probability groups 1

ECG Findings in Pulmonary Embolism

While ECG is commonly performed as part of the differential diagnosis workup 1, ECG findings in PE are nonspecific and cannot diagnose or exclude PE 2, 3.

Common ECG abnormalities in PE include:

• Sinus tachycardia (present in 40% of patients) 1
• T wave inversion in V1-V2 2
• Atrial arrhythmias, most frequently atrial fibrillation 1
• Signs of right ventricular strain in massive PE 3

Diagnostic Algorithm

For hemodynamically stable patients:

1. Assess clinical probability using Wells or Geneva scores 1, 4
2. In low clinical probability patients, apply PERC criteria—if all 8 criteria are met, no further testing needed 4, 5
3. Measure D-dimer (highly sensitive assay) in low/intermediate probability patients 1, 4
4. If D-dimer negative (<500 ng/mL), PE is excluded 4
5. If D-dimer elevated, proceed to CT pulmonary angiography (CTPA) 4

For hemodynamically unstable patients (high-risk PE):

• Bedside echocardiography or emergency CTPA is recommended depending on availability 1, 4
• Initiate IV unfractionated heparin with weight-adjusted bolus immediately without delay 1

Critical Pitfall

The most important caveat is not confusing cardiac diagnostic criteria (like Scarbossa) with PE diagnostic tools. ECG abnormalities in PE are supportive findings for differential diagnosis but cannot establish or exclude the diagnosis 1, 2. Overreliance on any single clinical tool without following evidence-based diagnostic algorithms is associated with increased VTE episodes and sudden death 4.