Four Clinical Decision Rules for Suspected PE Perform Equally Well

Several clinical decision rules (CDRs) are available to guide management of patients with suspected pulmonary embolism (PE); these CDRs use elements of medical history and physical exam to designate the pretest probability of PE as “likely” or “unlikely.” However, choosing one rule over another can be problematic because the rules have not been compared directly. Dutch researchers prospectively enrolled 807 patients with suspected acute PE and evaluated them with d-dimer testing and four CDRs: Wells rule, simplified Wells rule, original revised Geneva rule, and the simplified revised Geneva rule. Patients underwent computed tomography testing for PE if any CDR result was “PE-likely” or if d-dimer testing was positive. Patients with historie…