Ruling Out PE Without Imaging?

Chest imaging to evaluate low-risk patients for suspected pulmonary embolism (PE) can cause unnecessary radiation exposure and increase cost. Clinical decision rules (e.g., Wells, Geneva) in combination with low D-dimer levels can help rule out PE; however, D-dimer levels sometimes fall just above the accepted 500 ng/mL cutoff (or just above the newer, age-adjusted D-dimer cutoff).

Researchers in Spain and France randomized ≈1400 emergency department (ED) patients with low-to-moderate clinical risk for PE to an intervention group or to a control group:

• The intervention group was evaluated with a PE rule-out protocol. The protocol's requirement for avoiding advanced imaging was either (1) an absence of YEARS criteria and D-dimer level <1000 ng…