Simple and safe exclusion of pulmonary embolism using quantitative D-dimer and Wells simplified decision rule.

In conclusion, this large study has prospectively demonstrated the safety of excluding pulmonary embolism by the use of a dichotomous clinical decision rule and D-dimer test in patients with suspected pulmonary embolism. We have established that by implying such a non-invasive strategy anticoagulant therapy can safely be withheld with great efficiency involving more than 50 % of patients, thus obviating the need for more invasive and costly tests, including CT scan and perfusion lung scan. The standard approach in the diagnostic management of PE should now be to start with a clinical decision rule and a quantitative D-dimer test and rely on the outcome of these two tests. If the clinical decision rule indicates PE to be likely present or if the D-dimer test is abnormal, further imaging tests are warranted.

Excluding PE by a CDR indicating PE unlikely, assessed by the Wells simplified decision rule, combined with a normal D-dimer is safe and efficient.

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Upon clinical suspicion, Wells clinical decision rule was performed first and if patients had a score of 4.0 points, a D-dimer test followed. Patients with a normal D-dimer concentration had no further tests, pulmonary embolism was considered excluded and patients did not receive anticoagulant treatment.