Can a pregnancy-adapted algorithm safely avoid diagnostic imaging in pregnant women with suspected pulmonary embolism?

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Why is this study important?

The risk of venous thromboembolism (VTE) is increased during pregnancy and pulmonary embolism (PE) is a major cause of maternal mortality.[1] [2] [3] The incidence of pregnancy-associated PEs has been rising, albeit likely due to improved diagnostic capabilities. There are also maternal and fetal risks with investigations such as computed tomography pulmonary angiography (CTPA) and ventilation/perfusion (V/Q) lung scans albeit less than that of missed PE. The YEARS algorithm was designed to reduce the use of CTPA.[2] Applying it to pregnant patients could reduce maternal and fetal radiation exposure, emergency department (ED) length-of-stay, and resource utilization.[4]

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

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