Wells Criteria and D-Dimer to Exclude Pulmonary Embolism

Abstract This chapter appraises the use of the Wells criteria and D-dimer to exclude pulmonary embolism (PE) in emergency department (ED) patients. Combining pretest probability assessment with diagnostic tests, particularly D-dimer, effectively rules out PE in low-probability patients. The chapter recapitulates that using these criteria, along with a negative D-dimer result, can eliminate the need for further imaging, such as ventilation-perfusion scans. It demonstrates that D-dimer, when paired with the Wells score, provides a high negative predictive value, ensuring a reliable diagnostic process. Finally, the chapter suggests that advancements in D-dimer assays may have further improved the reliability of this method over time.