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Clinical prediction rules (e.g., Wells rule) and more-sensitive d-dimer assays dramatically improve our ability to rule out pulmonary embolism (PE). However, some data suggest that d-dimer testing might have a lower negative predictive value for patients who present several days after initial symptoms occur. To explore this issue, investigators examined data from two large prospective trials (NEJM JW Gen Med Jan 31 2006 and NEJM JW Gen Med Jun 23 2011) that involved 4044 hemodynamically stable patients with clinically suspected PE, 754 of whom had symptoms for >7 days before they presented for evaluation.
Compared with patients who presented within 7 days, those who presented later were older (mean age, 56 vs. 52), less likely to have venous…