Can We Limit Imaging in Hospitalized Patients with Suspected PE?

Although the modified Wells score and D-dimer testing can be used to rule out pulmonary embolism (PE) — without use of imaging — in outpatients with low-to-moderate risk, this strategy has not been validated for inpatients. In this meta-analysis of 12 diagnosis studies, researchers evaluated sensitivity and specificity of these two tests in nearly 4000 inpatients.

The modified Wells score alone (with cut-off of ≤4) had only moderate sensitivity (72%) and specificity (62%) for ruling out PE; adding D-dimer testing to the Wells score yielded excellent sensitivity (>99%) and negative likelihood ratio (LR−, 0.03). However, because D-dimer levels can be elevated in hospitalized patients for many reasons other than venous thromboembolism, this app…