Failure rate of D-dimer testing in patients with high clinical probability of pulmonary embolism: Ancillary analysis of three European studies

Methodology: 2.5/5
Usefulness: 2/5

Bannelier H, et al. Acad Emerg Med. 2025 Feb;32(2):116-122. doi: 10.1111/acem.15032. 

Editorial: D-dimer in high-risk pulmonary embolism workup.

Question and Methods: The authors performed a post-hoc analysis of three European studies to determine if D-dimer can be used to safely exclude PE in high-risk patients.
Findings: In patients deemed high risk for PE (Wells score > 6 or Geneva score > 10), there were no missed PEs in patients with negative D-dimer (failure rate 0%), resulting in a sensitivity of 100% (98.6-100%) and negative likelihood ratio of 0 (0 – 0.09).
Limitations: This retrospective analysis relies on original studies not designed for this question, with questionable chart review methods and a cohort where most patients lacked high PE probability (30% had PE), limiting conclusions.

Interpretation: This paper should not change our current practice. Continue to use D-dimer in low-moderate risk patients and don’t rely on D-dimer for high-risk patients.

Dr. Max Zworth

JC Supervisor: Dr. Krishan Yadav