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Cohort study
Pretest probability assessment combined with point-of-care D-dimer testing allows primary care physicians to rule out pulmonary embolism
  1. Christopher Kabrhel
  1. Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to : Christopher Kabrhel
    Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Place, Suite 3B, Boston, MA 02114, USA; ckabrhel{at}partners.org

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A Bayesian combination of pretest probability assessment and D-dimer testing to rule out pulmonary embolism (PE) has been extensively validated in secondary care settings such as emergency departments. If this approach is shown to be safe in primary care settings, point-of-care D-dimer assays could allow physicians to rule out PE without referring patients to secondary care.

Patients who present to primary care are different than those who present to secondary care. Whereas patients who seek emergency care do so because of the sudden onset of distressing symptoms, primary care patients typically have more indolent presentations. Clinical prediction rules (eg, Wells score) may perform less well when symptoms are subtle and subacute. Similarly, since the release of D-dimer trails off as emboli dissolve and are …

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