Related Experiment Video

Updated: Mar 21, 2026

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis

Published on: June 2, 2015

Wells Rule and d-Dimer Testing to Rule Out Pulmonary Embolism: A Systematic Review and Individual-Patient Data

Nick van Es, Tom van der Hulle, Josien van Es

Annals of Internal Medicine

|May 17, 2016

Abstract

Background:

The performance of different diagnostic strategies for pulmonary embolism (PE) in patient subgroups is unclear.

Purpose:

To evaluate and compare the efficiency and safety of the Wells rule with fixed or age-adjusted d-dimer testing overall and in inpatients and persons with cancer, chronic obstructive pulmonary disease, previous venous thromboembolism, delayed presentation, and age 75 years or older.

Data Sources:

MEDLINE and EMBASE from 1 January 1988 to 13 February 2016.

Study Selection:

6 prospective studies in which the diagnostic management of PE was guided by the dichotomized Wells rule and quantitative d-dimer testing.

Data Extraction:

Individual data of 7268 patients; risk of bias assessed by 2 investigators with the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool.

Data Synthesis:

The proportion of patients in whom imaging could be withheld based on a "PE-unlikely" Wells score and a negative d-dimer test result (efficiency) was estimated using fixed (≤500 µg/L) and age-adjusted (age × 10 µg/L in patients aged >50 years) d-dimer thresholds; their 3-month incidence of symptomatic venous thromboembolism (failure rate) was also estimated. Overall, efficiency increased from 28% to 33% when the age-adjusted (instead of the fixed) d-dimer threshold was applied. This increase was more prominent in elderly patients (12%) but less so in inpatients (2.6%). The failure rate of age-adjusted d-dimer testing was less than 3% in all examined subgroups.

Limitation:

Post hoc analysis, between-study differences in patient characteristics, use of various d-dimer assays, and limited statistical power to assess failure rate.

Conclusion:

Age-adjusted d-dimer testing is associated with a 5% absolute increase in the proportion of patients with suspected PE in whom imaging can be safely withheld compared with fixed d-dimer testing. This strategy seems safe across different high-risk subgroups, but its efficiency varies.

Primary Funding Source:

None.

More Related Videos

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis

Published on: February 10, 2023

The Application of Point-of-Care Ultrasonography (POCUS) in the Management of Acute Respiratory Distress Syndrome (ARDS) in the Intensive Care Unit

The Application of Point-of-Care Ultrasonography (POCUS) in the Management of Acute Respiratory Distress Syndrome (ARDS) in the Intensive Care Unit

Published on: December 12, 2025

Related Concept Videos

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...

Pulmonary Embolism III: Nursing Management

Pulmonary Embolism III: Nursing Management

A pulmonary embolism occurs when a thrombus, amniotic fluid, tumor tissue, fat, or air embolus blocks one or more pulmonary arteries. Effective nursing management and patient education are crucial for improving outcomes and preventing recurrence.Nursing management starts with obtaining a comprehensive patient history, particularly noting any history of deep vein thrombosis (DVT). Assess for clinical manifestations, including dyspnea, chest pain, crackles, heart murmurs, and signs of right-sided...

Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies

Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies

The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...

Pulmonary Embolism I: Introduction

Pulmonary Embolism I: Introduction

Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...

Venous Thrombosis III: Interprofessional Care

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...

Venous Thrombosis IV: Nursing Management

Venous Thrombosis IV: Nursing Management

Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...

Articles linked to this work by shared authors, journal, and citation graph.

ReSTORE-PE (Rehabilitation to Support Total Recovery after Pulmonary Embolism): Development of a co-designed rehabilitation programme for post-pulmonary embolism syndrome.

Thrombosis research·2026

Lipid lowering therapy in venous thromboembolism. A Clinical Consensus Statement of the ESC Working Group on Aorta and Peripheral Vascular Diseases, the ESC Working Group on Cardiovascular Pharmacotherapy, the ESC Working Group on Pulmonary Circulation & Right Ventricular Function, and the European Society of Vascular Medicine (ESVM).

European journal of preventive cardiology·2026

Antiphospholipid Syndrome in Chronic Thromboembolic Pulmonary Hypertension and Chronic Thromboembolic Pulmonary Disease without Pulmonary Hypertension: Prevalence and Clinical Impact in a Dutch Cohort.

TH open : companion journal to thrombosis and haemostasis·2026

Plasma protein profile in patients with antiphospholipid syndrome and controls without antiphospholipid syndrome.

Journal of thrombosis and haemostasis : JTH·2026

Quality of life and functional recovery after venous stent placement for postthrombotic syndrome: insights from the ARIVA multinational randomized trial.

Research and practice in thrombosis and haemostasis·2026

Risk-of-bias assessment in prognostic cohort studies: a methodological comparison study of structured appraisal tools in acute pulmonary embolism research.

BMJ open·2026

See all related articles