Based on Master Nickson's comments on the PE debate, you could argue this would be an acceptable paradigm. Using Wells as your entry forces gestalt into the equation. Since Wells' low risk arguably gets you somewhere between 1-6% in ED populations, PERC should be acceptable.
Clinical Guidelines from ACP include intermediate d-dimers, age-adjusted d-dimer (Ann Intern Med 2015;163:701)
Likely pretest prob patients are ruled out by neg CTA (Safety of multidetector computed tomography pulmonary angiography to exclude pulmonary embolism in patients with a likely pretest clinical probability. J Thromb Haemost. 2017 Jun 2. doi: 10.1111/jth.13746.)
Normalization of Vital Signs does not reduce probability of PE (https://coreem.net/journal-reviews/vs-normalization/)
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