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If clinical gestalt for PE is low, use PERC to rule out PE. If not ruled out, use a validated tool to determine pretest probability of PE: Wells, Revised Geneva, or simplified versions of either score. If non-high or "unlikely" pretest probability, order D-dimer, adjusting for age (<500 or <age x 10). If D-dimer is negative, PE is ruled out. If positive, order CT pulmonary angiogram.