The physician's estimation 'alternative diagnosis is less likely than pulmonary embolism' in the Wells rule is dependent on the presence of other required items.

摘要

Since the last decade, several clinical decision rules (CDRs) in the diagnostic process of pulmonary embolism (PE) have been proposed and validated (1-4). No rule has optimal sensitivity or specificity. It is for this reason that CDRs only have efficient clinical utility as a component of diagnostic strategies in combination with other simple bedside tests as D-dimer measurement (5-8). Indeed, in case of suspected PE, the combination of a low or intermediate (7) (in case of a trichotomised outcome) or less likely (5) (in case of dichotomised outcome) clinical probability with normal D-dimer tests safely rule out PE and oral anticoagulation therapy can safely be withheld in these patients.