A safe strategy to rule out pulmonary embolism: The combination of the Wells score and D-dimer test: One prospective study.

•Elderly patients are more likely to present with renal impairment and to develop contrast-induced nephropathy, which limits the use of CTPA.•With high false positive rate, the diagnostic accuracy of the Wells score or D-dimer test alone is unsatisfactory.•The combination of using the Wells score and D-dimer test is as effective as other complex diagnostic strategies in the evaluation and management of hospitalized elderly patients with clinically suspected PE.