{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:40:07Z","timestamp":1775090407647,"version":"3.50.1"},"reference-count":20,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2012,12,28]],"date-time":"2012-12-28T00:00:00Z","timestamp":1356652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100002999","name":"Dutch Ministry of Health, Welfare and Sport","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002999","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2013,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Rationale<\/jats:title><jats:p>To support doctors in diagnosing patients who are suspected to have pulmonary embolism, the <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>hristopher evidence\u2010based decision rule was implemented in hospitals in the <jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>etherlands. This study examines whether the <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>hristopher evidence\u2010based decision rule is applied in clinical practice. In addition, doctors' considerations for not applying the decision rule are explored.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Dyspnoea patients were included in the study prospectively. The diagnostic process of the patients with suspected pulmonary embolism, as judged by the treating doctor, was compared with the <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>hristopher evidence\u2010based decision rule using patient record reviews. In addition, 14 interviews were conducted with doctors who did not follow the <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>hristopher evidence\u2010based decision rule to obtain insights into their considerations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 80 of 247 dyspnoea cases, the treating doctors suspected pulmonary embolism. The <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>hristopher evidence\u2010based decision rule was applied in 17 out of 80 cases. In 22 cases, more tests were performed than was suggested by the decision rule [i.e. computer\u2010assisted tomographic angiography (<jats:styled-content style=\"fixed-case\">CTa<\/jats:styled-content>) or <jats:sc>d<\/jats:sc>\u2010dimer], while in 41 cases fewer tests were performed than suggested by the decision rule. Considerations for not following the decision rule included judging another diagnosis to be more likely and not wanting to expose the patient to <jats:styled-content style=\"fixed-case\">CTa<\/jats:styled-content> radiation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>hristopher evidence\u2010based decision rule for diagnosing pulmonary embolism was not always followed in everyday clinical practice. Doctors seem to base their diagnostic strategy on their own estimate of the likelihood of pulmonary embolism, rather than the whole decision rule. Better adherence to the decision rule could be beneficial by making doctors aware that pulmonary embolism is more likely than they initially thought. However, in a substantial number of cases, it seemed justifiable that doctors deviated from the decision rule. Therefore, further research is needed to determine the value of the <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>hristopher evidence\u2010based decision rule in clinical practice.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jep.12019","type":"journal-article","created":{"date-parts":[[2012,12,28]],"date-time":"2012-12-28T10:59:22Z","timestamp":1356692362000},"page":"682-688","source":"Crossref","is-referenced-by-count":5,"title":["Application of an evidence\u2010based decision rule to patients with suspected pulmonary embolism"],"prefix":"10.1111","volume":"19","author":[{"given":"Laura","family":"Zwaan","sequence":"first","affiliation":[{"name":"Department of Internal Medicine VU University Medical Center  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abel","family":"Thijs","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine VU University Medical Center  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cordula","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Public and Occupational Health, EMGO Institute for Health and Care Research VU University Medical Center  Amsterdam The Netherlands"},{"name":"NIVEL, Netherlands Institute for Health Services Research  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dani\u00eblle R. 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