Which diagnostic tests are recommended for confirming a suspected pulm

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Diagnostic tests recommended for confirming suspected pulmonary embolism (PE) in primary care settings:

First, assess clinical probability using the two-level PE Wells score. A score of more than 4 points indicates PE is likely, and 4 or less indicates PE is unlikely. This clinical assessment guides further testing ,.
For people with a Wells score of 4 or less (PE unlikely), offer a D-dimer test with results available within 4 hours. If the D-dimer test is negative, PE is unlikely, and no further immediate testing is needed ,.
If the D-dimer test is positive, arrange urgent hospital admission for a computed tomography pulmonary angiogram (CTPA) or, if contraindicated, a ventilation/perfusion (V/Q) scan. If immediate imaging is not possible, start interim therapeutic anticoagulation and arrange hospital admission ,.
For people with a Wells score greater than 4 (PE likely), arrange immediate hospital admission for CTPA or V/Q scan. If imaging cannot be done immediately, start interim therapeutic anticoagulation and admit ,.
In primary care, chest X-ray should be offered to exclude alternative diagnoses in people presenting with signs or symptoms of PE .
Point-of-care D-dimer testing may be considered if laboratory facilities are not immediately available, preferably using a fully quantitative test and considering age-adjusted thresholds for people over 50 years .
For pregnant or postpartum women with suspected PE, immediate hospital referral for objective testing is recommended, as D-dimer testing and Wells score are not validated in pregnancy .

Which diagnostic tests are recommended for confirming a suspected pulmonary embolism in primary care settings?