Can application of the YEARS algorithm safely exclude pulmonary embolism?

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Why is this study important?

The YEARS diagnostic algorithm is a novel, simplified diagnostic management approach for patients with suspected pulmonary embolism (PE) that was developed, in part, to reduce ccomputed tomography pulmonary angiography (CTPA) imaging.[1] The YEARS strategy combines items from the Well’s score with an increased D-dimer cutoff at presentation and has been prospectively tested in a multicentre, cohort study in the Netherlands. In an attempt to externally validate this strategy in an independent cohort, the authors of this study retrospectively applied the YEARS algorithm to the patients with suspected PE from 3 published prospective cohort studies and then conducted a meta-analysis.

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

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