Minimizing unnecessary testing is one of the primary ways to limit costs and time. This begins with utilizing either clinical gestalt or clinical decision rules to identify the pretest probability of PE and those specific patients who require no diagnostic testing to evaluate for PE. Once the decision to pursue diagnostic testing has been made, only those tests with the ability to significantly alter pretest probability should be considered. Arterial blood gas sampling, qualitative D-dimer tests, and pro-brain natriuretic peptide levels do not have the ability to affect pretest probability in any risk group, so these tests should not be used in the risk assessment for PE.
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