Surreal illustration of lungs and a D-dimer molecule, symbolizing precision in pulmonary embolism diagnosis.

Pulmonary Embolism: Are You Missing the Signs? Understand Risk Factors and Improve Detection

Samir D’Costa in Health & Wellness November 2025 • 4 min read.

"Optimize pulmonary embolism diagnosis using D-dimer testing with innovative clinical decision rules for low-risk patients."

Pulmonary embolism (PE), a condition where blood clots block arteries in the lungs, remains a significant health challenge. It's crucial for healthcare providers to accurately diagnose PE to ensure timely treatment and reduce potential complications. Often, the initial assessment involves determining the patient's risk level and using D-dimer tests to help rule out PE, especially in low-risk individuals.

Traditional D-dimer testing has limitations, particularly its low specificity, which can lead to unnecessary imaging and increased healthcare costs. To address this, researchers have explored alternative clinical decision rules (CDRs) and D-dimer thresholds. These include age-adjusted D-dimer levels and the YEARS criteria, aiming to improve diagnostic accuracy and reduce the need for excessive testing.

This article delves into a recent study comparing the effectiveness of different CDRs and D-dimer thresholds for low-risk PE patients. By understanding the findings, healthcare professionals and patients alike can make informed decisions, reduce unnecessary interventions, and enhance patient outcomes.

Understanding Pulmonary Embolism and the Role of D-Dimer Testing

Surreal illustration of lungs and a D-dimer molecule, symbolizing precision in pulmonary embolism diagnosis.

Pulmonary embolism occurs when a blood clot travels to the lungs, blocking one or more arteries. Symptoms can vary widely, from shortness of breath and chest pain to more subtle signs. Because PE can be life-threatening if not promptly treated, rapid and accurate diagnosis is essential. The challenge lies in distinguishing PE from other conditions with similar symptoms.

D-dimer testing is a common tool used to rule out PE, particularly in patients considered low-risk based on clinical assessment. D-dimer is a protein fragment produced when a blood clot breaks down. A negative D-dimer result suggests that a blood clot is unlikely, while a positive result indicates the need for further investigation, often through imaging studies like CT pulmonary angiography (CTPA).

Traditional D-dimer testing uses a fixed threshold (e.g., 0.5 µg/mL) to determine whether further imaging is needed. However, this approach can lead to overdiagnosis and unnecessary radiation exposure.
Age-adjusted D-dimer levels increase the threshold based on the patient's age, reducing false positives in older individuals.
YEARS criteria combine specific clinical criteria with a D-dimer threshold to guide decision-making.

These alternative approaches aim to improve the balance between sensitivity (correctly identifying patients with PE) and specificity (correctly identifying patients without PE). The goal is to reduce unnecessary imaging while ensuring that PE is not missed.

The Future of PE Diagnosis: Personalized and Precise

The study highlighted in this article underscores the importance of refining diagnostic strategies for pulmonary embolism. By adopting more nuanced approaches like age-adjusted D-dimer thresholds and the YEARS criteria, healthcare providers can reduce unnecessary imaging, lower healthcare costs, and minimize patient exposure to radiation. Further research and larger multi-center trials will help validate these findings and pave the way for even more personalized and precise diagnostic algorithms. Stay informed, ask questions, and work with your healthcare provider to ensure you receive the most appropriate and effective care.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1111/imj.14138, Alternate LINK

Title: Comparison Of Wells And Years Clinical Decision Rules With D‐Dimer For Low‐Risk Pulmonary Embolus Patients

Subject: Internal Medicine

Journal: Internal Medicine Journal

Publisher: Wiley

Authors: Christopher J. Mclenachan, Olivia Chua, Betty S. H. Chan, Elia Vecellio, Angela L. Chiew

Published: 2019-06-01

Everything You Need To Know

What exactly is pulmonary embolism, and how does D-dimer testing play a role in its diagnosis?

Pulmonary embolism (PE) occurs when a blood clot obstructs one or more arteries in the lungs. Prompt treatment is vital because PE can be life-threatening. D-dimer testing is a common method to rule out PE, especially in low-risk patients. A negative D-dimer suggests a blood clot is unlikely, while a positive result usually warrants further investigation, such as CT pulmonary angiography (CTPA). However, D-dimer tests can sometimes produce false positives, leading to unnecessary testing and anxiety.

How do age-adjusted D-dimer levels and the YEARS criteria differ from traditional D-dimer testing in diagnosing pulmonary embolism?

Traditional D-dimer testing uses a fixed threshold to determine the need for further imaging, which can lead to overdiagnosis and unnecessary radiation exposure. Age-adjusted D-dimer levels increase the threshold based on a patient's age, reducing false positives, particularly in older individuals. The YEARS criteria combine specific clinical criteria with a D-dimer threshold to guide decision-making, further refining the diagnostic process. These alternative approaches aim to improve the balance between sensitivity and specificity in PE diagnosis.

What are the specific clinical criteria used in the YEARS approach, and how does combining these with D-dimer levels improve diagnostic accuracy for pulmonary embolism?

The YEARS criteria represent an advancement over traditional D-dimer testing by incorporating clinical criteria alongside D-dimer levels. This approach helps to better identify patients who truly require further imaging. The specific clinical criteria used in the YEARS approach are not detailed, but by combining clinical assessment with D-dimer results, the YEARS criteria can potentially reduce unnecessary CTPA scans and improve patient outcomes. More detail on the specific criteria would improve understanding.

What are the benefits of using refined diagnostic strategies, such as age-adjusted D-dimer thresholds and the YEARS criteria, in the management of pulmonary embolism?

Refining diagnostic strategies, such as using age-adjusted D-dimer thresholds and the YEARS criteria, can lead to several benefits. These include reducing unnecessary imaging, lowering healthcare costs, and minimizing patient exposure to radiation. This personalized approach ensures that patients receive the most appropriate and effective care, improving overall outcomes and satisfaction.

What further research is needed to enhance diagnostic algorithms for pulmonary embolism, and how could this lead to more personalized and precise care?

Further research, including larger multi-center trials, is essential to validate the findings related to age-adjusted D-dimer thresholds and the YEARS criteria. Such studies would help confirm the effectiveness of these approaches across diverse patient populations and healthcare settings. Additionally, ongoing research could explore even more personalized diagnostic algorithms, potentially incorporating genetic markers or other biomarkers to further refine PE diagnosis and treatment strategies.