What Are the Parameters That Should Inform Gestalt as a Clinical Decision Strategy for Pulmonary Embolism?

The limitations of clinical decision rules1 are exemplified by the performance of the Wells criteria in primary care.2 The latter study enrolled 598 patients in whom the general practitioner considered that pulmonary embolism might be present. Suspicion of pulmonary embolism was based on the presence of 1 or more of the following symptoms: unexplained (sudden) dyspnea, deterioration in existing dyspnea, pleuritic pain, and unexplained cough. After recording the Wells score, the primary care doctor was required to refer the patient to secondary care for further evaluation.