Diagnostic accuracy of triage tests to exclude pulmonary embolism

Thromb Haemost. 2001 Jun;85(6):995-8.


We performed a study in 403 prospectively included patients with suspected pulmonary embolism to compare the accuracy of a combination of the SimpliRED D-dimer assay and an intuitive clinical probability estimate with either one alone. Based on a conjoint diagnostic refer, ence standard, including ventilation-perfusion lung scintigraphy and pulmonary angiography, the prevalence of pulmonary embolism was 31%. We demonstrated a high sensitivity (98%, 95% CI 95-100) and negative predictive value (94%, 95% CI 79-99) for the combination of the two tests. These figures were more favorable than for either test alone. The specificity of the combination was lower (11%, 95% CI 9-12) and consequently the proportion of patients in whom further diagnostic tests would have been avoided was only 8%. We conclude that the combined use of the SimpliRED test and the clinical probability estimate attains a higher sensitivity than either test alone. However, there remains a risk of false negatives and the exclusion efficiency is limited.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Algorithms
  • Angiography
  • Cohort Studies
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Pulmonary Embolism / blood
  • Pulmonary Embolism / diagnosis*
  • Pulmonary Embolism / diagnostic imaging
  • Radionuclide Imaging
  • Reagent Kits, Diagnostic / standards
  • Sensitivity and Specificity
  • Triage / methods
  • Triage / standards*


  • Fibrin Fibrinogen Degradation Products
  • Reagent Kits, Diagnostic
  • fibrin fragment D