TY - JOUR T1 - Pretest probability assessment combined with point-of-care D-dimer testing allows primary care physicians to rule out pulmonary embolism JF - Evidence Based Medicine JO - Evid Based Med SP - 187 LP - 188 DO - 10.1136/eb-2012-101120 VL - 18 IS - 5 AU - Christopher Kabrhel Y1 - 2013/10/01 UR - http://ebm.bmj.com/content/18/5/187.abstract N2 - Commentary on: Geersing GJ, Erkens PM, Lucassen WA, et al. Safe exclusion of pulmonary embolism using the Wells rule and qualitative D-dimer testing in primary care: prospective cohort study. BMJ 2012;345:e6564.OpenUrlAbstract/FREE Full Text 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 … ER -