In reply:

Abstract

We thank Dr. Akhter et al1Akhter M. Kline J. Kannan V. et al.Discrepancy between clinician gestalt and subjective component of the wells score in the workup of pulmonary embolism.Ann Emerg Med. 2018; 71: 796-798Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar for their thoughtful comments in regard to our recent article and for sharing review of their data about the pulmonary embolism rule-out criteria. Their data confirm what many studies have shown before: that clinician gestalt often equals or outperforms clinical decision aids. We urge readers who have not already done so to read “The Rush From Judgment,” an editorial on this subject that recently appeared in Annals.2Wears R.L. Klein G.K. The rush from judgment.Ann Emerg Med. 2017; 70: 346-347Abstract Full Text Full Text PDF Scopus (4) Google Scholar In that article, Drs. Wears and Klein write:“It is dishonest to promote decision aids as advancing rational practice while failing to compare them with the baseline case of unaided clinical judgment. Reports on decision aids should routinely compare their performance to the unaided clinical judgments they are ostensibly designed to support.” The comments by Dr. Akhter et al provide further evidence for why the advice given by Drs. Wears and Klein should be heeded. Discrepancy Between Clinician Gestalt and Subjective Component of the Wells Score in the Evaluation of Pulmonary EmbolismAnnals of Emergency MedicineVol. 71Issue 6PreviewSchriger et al1 recently showed that studies rarely compare decision aids with physician judgment. In the evaluation of pulmonary embolism, clinicians may use either their subjective clinical judgment (ie, gestalt) or a decision aid (eg, Wells score) to determine the pretest probability of pulmonary embolism. Research shows that the Wells score and clinical gestalt are similarly accurate.2,3 Research also suggests that most of the predictive power of the Wells score lies in its subjective question, “Are alternative diagnoses less likely than pulmonary embolism?”4 However, the degree to which the subjective component of the Wells score and clinician gestalt are correlated is not known. Full-Text PDF