Prediction Rules Combined with Point-of-Care D-Dimer Testing for Ruling Out Pulmonary Embolism

How accurate are prediction rules, combined with point-of-care D-dimer testing, for ruling out pulmonary embolism (PE) in the primary care setting? In a systematic review followed by a validation study, researchers assessed five rules and specific score thresholds: original Wells (≤4), modified Wells (≤2), simplified Wells (≤1), revised Geneva (≤5), and simplified revised Geneva (≤2). The validation study involved 600 patients with suspected PE in 300 Dutch general practices.

Sensitivities of three Wells rules, combined with point-of-care D-dimer testing, were higher (95%–96%) than sensitivities of the two Geneva rules (88% and 90%). For each rule, specificity was about 50% and positive predictive value was about 20%. Negative predictive val…