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Testing a bedside rule to reduce unneeded scans for pulmonary embolism in emergency care

Checks the Adjust-Unlikely rule in emergency patients suspected of having pulmonary embolism.

Key facts

Who runs it
Dr. Kerstin de Wit
Where
Canada4 sites in 1 countryChoose a country to see its sites
Trial code
Registry title
Emergency Medicine Pulmonary Embolism Testing Multicentre Study
Status
Recruiting
People taking part
4,000 people, planned
Started
1 Jan 2024
Expected to end
30 Sept 2027
Type of study
Observational
Treatments tested
  • Adjust-Unlikely
Record updated
20 April 2026

Who can take part

AI summary

From the trial's eligibility criteria. Machine-read from the registry text on this page, so it can be wrong. The registry text below and the trial team decide who can take part.

The trial is looking for adults in the emergency department who are being tested by an emergency doctor for a blood clot in the lungs (pulmonary embolism, PE). It checks a new decision tool called Adjust-Unlikely.

Age
18 years and older
Sex
All sexes
Disease stage
Suspected pulmonary embolism, being tested for it during an emergency visit
Earlier treatment
People cannot join if they started treatment for a presumed PE before PE testing. They also cannot join if they had PE or leg clot imaging (CT pulmonary angiogram, ventilation-perfusion scan or lower limb ultrasound) within the prior 30 days.
Biomarker or test result
A D-dimer blood test must be done and have a result during the emergency visit.

Main reasons for not taking part

  • A new reason (not PE) to take blood thinners
  • Past leg vein clot with no earlier ultrasound scan on record
  • Transferred from another hospital
  • Not living in Ontario or no valid Ontario Health Insurance Plan card
  • Leaving against medical advice, or opted out of all research at the site

The registry criteria, word for word

Show all 16 criteriaShow less

Who can take part

  • Emergency department patient who is tested by an emergency physician for PE

Who cannot take part

  • The D-dimer is ordered prior to the physician assessing the patient
  • The patient has previously registered that they opt out of all research at the participating site
  • The patient has had PE or deep vein thrombosis imaging (CT pulmonary angiogram, ventilation-perfusion scan or lower limb ultrasound) within prior 30 days
  • The patient was initiated on treatment for presumed PE prior to PE testing
  • The patient has previously been enrolled into the study
  • The patient has a prior history of lower extremity deep vein thrombosis without availability of a baseline ultrasound scan
  • Patient is < 18 years of age
  • No documentation of whether PE is the most likely diagnosis
  • D-dimer is not tested or else not resulted during the emergency visit
  • The D-dimer level is known before documentation of whether PE is the most likely diagnosis
  • The patient leaves against medical advice
  • There is a new (non-PE) indication for anticoagulation
  • The patient was transferred from another hospital organization
  • The patient does not reside in Ontario
  • The patient has no valid Ontario Health Insurance Plan card

This trial has no sites in United States.

It has sites in one country. Choose a country to see its sites.

About the trial

What the trial wants to find out

It is important to diagnose pulmonary embolism in a timely manner to prevent death and long-term disability. More than half a million people (4-5% of emergency department patients) are tested for pulmonary embolism, although the positive rate is low. Imaging for PE testing exposes patients to radiation, is expensive, adds time to the emergency visit, and can lead to a false positive diagnoses. Existing protocols aimed at reducing unnecessary pulmonary embolism imaging are complex and seldom used by emergency physicians. Too many patients undergo unnecessary pulmonary embolism imaging.

Read full original descriptionShow less

A new tool (called Adjust-Unlikely) could safely reduce pulmonary embolism imaging in Canada. A research group composed of researchers, emergency physicians, and patients developed the Adjust-Unlikely clinical decision rule: a rule which has been customized for emergency physicians and emergency patients. Adjust-Unlikely is highly sensitive at the bedside, meaning there are very few false negative results.

The study aim is to prospectively validate Adjust-Unlikely pulmonary embolism testing in emergency patients with suspected pulmonary embolism.

The group in the trial

  • Emergency department patients tested for pulmonary embolism.

    Treatment: Adjust-Unlikely

Questions to ask the study team

  1. How often do I need to come in, and for how long each time?
  2. Are travel costs paid?
  3. Can I keep my own doctor?
  4. What happens if I want to stop?

Contact the study team: see the registry record → Contacts and Locations

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Data and sources

Registry record
Listed on ClinicalTrials.gov.
Official title
Emergency Medicine Pulmonary Embolism Testing Multicentre Study
Plain-language title
Testing a bedside rule to reduce unneeded scans for pulmonary embolism in emergency careGenerated from the registry record. The registry title is the official one.
AI summary
From the trial's eligibility criteria. Read by machine on 15 November 2026.
Record updated
20 April 2026