Table 1 Clinical decision rules under evaluation
| Wells’ score [21] | Revised Geneva [22] | PERC [23] | YEARS [24] | ||
|---|---|---|---|---|---|
| Items | CDR points | Items | CDR points | Items | Items |
| Previous VTE | 1.5 | Previous VTE | 3 | Age < 50 y | Clinical signs of DVT |
| Heart rate > 100/min | 1.5 |
Heart rate 75–94/min ≥ 95/min |
3 5 | Pulse < 100/min | Hemoptysis |
| Surgery or immobilization < 4 weeks | 1.5 | Surgery or fracture < 1 month | 2 | Saturation > 94% | PE most likely diagnosis |
| Hemoptysis | 1 | Hemoptysis | 2 | No unilateral leg swelling |
Clinical probability: 0 items and D-dimer < 1000 ng/ml: PE ruled out 0 items and D-dimer ≥ 1000 ng/ml: Likely ≥ 1 items and D-dimer < 500 ng/ml: PE ruled out ≥ 1 items and D-dimer ≥ 500 ng/ml: Likely |
| Active cancer | 1 | Active cancer | 2 | No hemoptysis | |
| Clinical signs of DVT | 3 | Unilateral lower limb pain | 3 | No recent trauma or surgery | |
| Alternative diagnosis less likely than PE | 3 | Pain on lower limb, deep venous palpation, and unilateral edema | 4 | No estrogen use | |
|
Clinical probability: Low < 2 total Intermediate 2–6 total High > 6 total Unlikely ≤ 4 Likely > 4 | Age > 65 years | 1 | No previous VTE | ||
|
Clinical probability: Low 0–3 Intermediate 4–10 High ≥ 11 |
Clinical probability: PE ruled out when fulfilling these criteria | ||||
|
Further testing: • “Unlikely,” “Low,” or “Intermediate” plus abnormal D-dimer testing, and • “High”, or “Likely”, regardless of D-dimer testing (i.e., D-dimer testing not indicated) In all other patients, PE is considered ruled-out. |
Further testing: • “Low”, or “Intermediate” plus abnormal D-dimer testing. • “High”, regardless of D-dimer testing (i.e., D-dimer testing not indicated) In all other patients, PE is considered ruled-out. |
Further testing: All patients fulfilling at least one PERC item. In all other patients, PE is considered ruled-out. |
Further testing: All patients classified into “Likely”. In all other patients, PE is considered ruled-out. | ||