EBQ:Wells PE Rule Out

incomplete Journal Club Article

Wells PS et al. "Excluding Pulmonary Embolism at the Bedside without Diagnostic Imaging: Management of Patients with Suspected Pulmonary Embolism Presenting to the Emergency Department by Using a Simple Clinical Model and D-Dimer". Annals of Internal Medicine. 2001. 135(2):98-107.
PubMed Full text PDF

Clinical Question

Is there a simple clinical model along with d-dimer assay testing that can be used to manage patients presenting to the emergency department with suspected pulmonary embolism?

Study Design

Prospective Cohort Study of 4 tertiary care hospitals in Canada

Review Questions

1 The utility of a quantitative D-dimer test is greatest in which of the following patients suspected of a pulmonary embolism?

	Patients with a low pre-test probability
	Patients with an intermediate pre-test probability
	Patients with a high pre-test probability

2 In which of the following patients can a negative CT pulmonary angiogram (alone) exclude the diagnosis of PE?

	A patient with low pretest probability who required additional diagnostic testing because of a positive D-dimer
	A patient with an intermediate pretest probability with a negative CT pulmonary angiogram in whom you are still concermed for PE
	A patient with an intermediate pretest probability with a negative d-dimer and a negative CT pulmonary angiogram
	Neither of the above

3 When would venous ultrasound be indicated as the initial imaging modality when you are evaluating a person with symptoms consistent with PE?

	Patients with obvious signs of DVT for whom venous ultrasound is readily available
	Patients with borderline renal insufficiency
	Patients with CT contrast agent allergy
	Pregnant patient
	All of the above