• Petra M G Erkens, Wim A M Lucassen, Geert-Jan Geersing, Henk C P M van Weert, Marlous Kuijs-Augustijn, Marloes van Heugten, Lonneke Rietjens, Hugo ten Cate, Martin H Prins, Harry R Büller, Arno W Hoes, Karel G M Moons, Ruud Oudega, and Henri E J H Stoffers.
• Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Department of Internal Medicine, Laboratory for Clinical Thrombosis and Haemostasis, Cardiovascular Research Institute Maastricht (CARIM) and Department of Clinical Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, petra.erkens@maastrichtuniversity.nl.
• Fam Pract. 2014 Dec 1;31(6):670-7.

IntroductionPulmonary embolism (PE) often presents with nonspecific symptoms and may be an easily missed diagnosis. When the differential diagnosis includes PE, an empirical list of frequently occurring alternative diagnoses could support the GP in diagnostic decision making.ObjectivesTo identify common alternative diagnoses in patients in whom the GP suspected PE but in whom PE could be ruled out. To investigate how the Wells clinical decision rule for PE combined with a point-of-care d-dimer test is associated with these alternative diagnoses.MethodsSecondary analysis of the Amsterdam Maastricht Utrecht Study on thrombo-Embolism (Amuse-2) study, which validated the Wells PE rule combined with point-of-care d-dimer testing in primary care. All 598 patients had been referred to and diagnosed in secondary care. All diagnostic information was retrieved from the GPs' medical records.ResultsIn 516 patients without PE, the most frequent alternative diagnoses were nonspecific thoracic pain/dyspnoea (42.6%), pneumonia (13.0%), myalgia (11.8%), asthma/chronic obstructive pulmonary disease (4.8%), panic disorder/hyperventilation (4.1%) and respiratory tract infection (2.3%). Pneumonia occurred almost as frequent as PE. Patients without PE with either a positive Wells rule (>4) or a positive d-dimer test, were more often (odds ratio = 2.1) diagnosed with a clinically relevant disease than patients with a negative Wells rule and negative d-dimer test.ConclusionIn primary care patients suspected of PE, the most common clinically relevant diagnosis other than PE was pneumonia. A positive Wells rule or a positive d-dimer test are not only positively associated with PE, but also with a high probability of other clinically relevant disease.© The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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