Can computed tomographic pulmonary angiography safely exclude pulmonary embolism?

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Why is this study important?

Computed tomographic pulmonary angiography (CTPA) has been endorsed as the reference standard test for ruling in and ruling out pulmonary embolism (PE) regardless of pretest probability.[1] This systematic review shows, unsurprisingly, that CTPA is not perfectly sensitive for PE. There are some false negatives, and if the probability of PE before the negative CTPA is very high, the probability of PE after a negative CTPA can still be significant.

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

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