• Intermediate pretest probability of PE: D-dimer testing is the first step. A negative D-dimer has sufficient negative predictive value to eliminate the need for further testing. An elevated D-dimer, ideally adjusted for age, should prompt evaluation by CTPA.
• High pretest probability of PE: In patients with a high pretest probability secondary to either clinical gestalt or a clinical prediction tool, evaluation by CTPA is warranted.
References
• “Evaluation of Patients With Suspected Acute Pulmonary Embolism: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians.” Ann Intern Med. 2015 Nov 3;163(9):701-11.
Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital. Dr. Vandergrift is a first-year resident in the program.