Methods:

This was a multicenter, international, prospective management outcome study of consecutive patients with a clinical suspicion of PE (defined as an acute onset or worsening shortness of breath or chest pain without another obvious etiology). Clinical probability was assessed with the simplified, revised Geneva score or the two-level Wells score. Those patients with a high or a likely clinical probability directly proceeded to imaging with computed tomography to evaluate for PE. D-dimer testing was performed in those with low, intermediate, or unlikely probability of PE. PE was excluded in those with a D-dimer value lower than 500 µg/L. In patients 50 years or older, an age-adjustment was performed for the D-dimer value, which was considered negative in those with a value lower than their age multiplied by 10. All patients had follow-up for 3 months. The primary outcome was the rate of adjudicated and symptomatic thromboembolic events during follow-up among patients not treated with anticoagulants on the basis of a negative D-dimer test result according to the age-adjusted cutoff.