To the Editor We read with great interest the article by Roy et al1 describing a new 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS) to rule out pulmonary embolism (PE). As recommended by the Scientific and Standardization Committee of the International Society of Thrombosis and Hemostasis,2 the authors predefined the acceptable upper limits of the 95% CI of failure rate at 1.93% and 1.88% for their 2 external validation cohorts. The authors found the failure rates and 95% CI of the 4PEPS below these predefined limits and concluded that the safety of the 4PEPS strategy was confirmed.
Freund Y, Roussel M, Behringer W. Safety of the 4PEPS in Patients With a Very Low Prevalence of Pulmonary Embolism—Need for More Than a Point Estimate. JAMA Cardiol. 2021;6(12):1468. doi:10.1001/jamacardio.2021.4014
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