Can pulmonary embolism be ruled out through a combination of clinical assessment and d-Dimer testing?

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Why is this study important?

Computed tomography pulmonary angiography (CTPA) for pulmonary embolism (PE) is costly, time-consuming, and exposes the patient to radiation and the potential risks associated with intravenous (IV) contrast. The combination of a low clinical pretest probability (PTP) and a d-dimer of < 500 ng/ml can avoid CTPA in approximately 30% of patients[1]. This study was to determine if increasing the d-Dimer or PTP thresholds (i.e. the Pulmonary Embolism Graduated d-Dimer [PEGeD] strategy) can safely rule out PE without CTPA.

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

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