Journal Club Summary
Methodology Score: 3/5
Usefulness Score: 3/5
Douma RA, Mos IC, et al. Prometheus Study Group.
This European study directly compared four clinical decision rules in combination with d-dimer testing to exclude PE without the need for CT and found similar performance with very high sensitivity for all four; the authors concluded that simplified Wells or Geneva scores can be used. Limitation to usefulness in the ED include the fact that the study included 20% inpatients, the outpatient group did not stipulate that it was an ED population, exclusion criteria included patients with a previous diagnosis of PE even though this is factored into all four CDRs, and the fact that many Canadian ED physicians already use the simplified Wells score.
By: Dr. Laura Francis