What is the efficiency and failure rate of diagnostic strategies for ruling out pulmonary embolism?

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Why is this study important?

While several studies have validated the clinical utility of the Wells score combined with age adjusted D-dimer testing in excluding PE,[1][2] the efficiency and safety in certain patient subgroups (cancer, chronic obstructive pulmonary disease [COPD], prior venous thrombosis, late presenters, older patients, and inpatients) remains unclear.

Which, if any, threats to validity are most likely to have an impact on the results and how?

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