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Related Experiment Video

Updated: Nov 15, 2025

Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease

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Derivation and Validation of a 4-Level Clinical Pretest Probability Score for Suspected Pulmonary Embolism to Safely

Pierre-Marie Roy¹, Emilie Friou², Boris Germeau³

¹Emergency Department, CHU Angers, Institut Mitovasc UMR (CNRS 6015-INSERM 1083), UNIV Angers, F-CRIN INNOVTE, Angers, France.

JAMA Cardiology

|March 3, 2021

Summary

The new 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS) safely reduces diagnostic imaging for suspected pulmonary embolism (PE). This clinical rule-out strategy decreases unnecessary testing while maintaining high accuracy.

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Area of Science:

Pulmonary Medicine
Diagnostic Imaging
Clinical Decision Rules

Background:

Overutilization of diagnostic imaging for suspected pulmonary embolism (PE) is a significant clinical concern.
Current diagnostic strategies may lead to unnecessary radiation exposure and healthcare costs.

Purpose of the Study:

To develop and validate the 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS).
To enable safe exclusion of PE using clinical criteria and D-dimer testing, thereby reducing imaging utilization.

Main Methods:

A 4-level pretest probability rule (4PEPS) was derived and validated using data from over 11,000 outpatients with suspected PE.
The 4PEPS incorporates 13 clinical variables and guides the use of D-dimer testing or imaging based on calculated probability.
External validation was performed on two independent cohorts to assess the strategy's performance.

Main Results:

The 4PEPS strategy demonstrated high accuracy in external validation cohorts (AUCs of 0.79 and 0.78).
The strategy resulted in low false-negative rates (0.71% and 0.89%) and significant reductions in imaging testing (-22% and -19%).
The 4PEPS approach outperformed recent strategies in reducing imaging utilization.

Conclusions:

The 4PEPS strategy offers a substantial and safe method for decreasing diagnostic imaging in patients with suspected PE.
Further evaluation in a formal outcome study is recommended to confirm clinical utility.