An Alternate Route to Ruling Out Pulmonary Embolism—But Is It Safe?

Multiple tools to detect pulmonary embolism are at the urgent care provider’s disposal. And yet, misses happen. The Journal of the American Medical Association just published an article on research that tested an alternate method to detect PE, combining the YEARS rule with age-adjusted D-dimer threshold—and the authors concluded that this method “did not lead to an inferior rate of thromboembolic events compared with a conventional diagnostic strategy.” The cluster-randomized crossover noninferiority study focused on 823 women and 591 men, mean age 55 years, who had a low risk for PE not excluded by the pulmonary embolism rule-out criteria (PERC) rule or subjective clinical intermediate risk for PE in 18 emergency departments in France and Spain. Primary outcome was venous thromboembolism at 3 months. In the end, risk of a thromboembolic event was 0.15% for the novel intervention group, compared with 0.80% for the conventional group. If you found this enlightening, you should check out JUCM’s November cover article, Urgent Care Diagnosis and Management of Deep Vein Thrombosis.