GPs can rule out PE with Wells, D-dimer
medwireNews: GPs can use the Wells clinical decision rule and the D-dimer test to rule out pulmonary embolism (PE), show the results of the first validation study in primary care.
The study included 598 Dutch patients, aged an average of 48 years, who presented to their GP with suspected PE. In all, 68 patients had a PE detected after referral, with a further five patients diagnosed with venous thromboembolism during the 3-month follow-up.
The GPs assessed patients' Wells score, which is based on seven items and has a maximum score of 12.5. Scores of 4 or lower or less than 2 have previously been proposed as cut-off values for low risk. D-dimer tests were also performed.
Overall, 272 patients had a negative D-dimer test result and a Wells score of 4 or less. Of these patients who were categorised as low risk, four were diagnosed with PE. This equated to a failure rate of 1.5%.
When the threshold for the Wells score was restricted to less than 2, two patients out of 168 in this group had a PE, resulting in a failure rate of 1.2%.
The authors say that GPs - often the first to be consulted by patients with symptoms of PE - typically have low thresholds for hospital referrals of suspected PE due to the fear of missing a case. They believe their findings could help give clinicians confidence in their decision-making.
"Such a rule-out strategy makes it possible for primary care doctors to safely exclude pulmonary embolism in a large proportion of patients suspected of having the condition, thereby reducing the costs and burden to the patients associated with an unnecessary referral to secondary care," write Dr Geert-Jan Geersing (University Medical Center Utrecht, Netherlands) and colleagues in the BMJ.
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By Kirsty Oswald