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

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 ¹,².
• 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 ¹,².
• 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 ¹,².
• 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 ¹,².
• In primary care, chest X-ray should be offered to exclude alternative diagnoses in people presenting with signs or symptoms of PE ¹.
• 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 ¹.
• 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 ².