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1. The pretest probability of 15% is very clinician-dependent, and difficult to apply in practice to the care of the indivifual patient.
2. Validation studies of patients testing negative pulmonary embolism rule out criteria (PERC) report a diagnosis of pulmonary embolism of 1%. In a relatively small emergency unit like hours this would translate in 4 missed diagnoses of pulmonary embolism. Is this acceptable ?