Background: Venous thromboembolism is a leading cause of morbidity and mortality in the United States. Accurate and timely diagnosis may be confounded by its nonspecific clinical presentation. Wells Criteria is a reliable screening tool with high sensitivity; however, recent data suggest that D-dimer is increasingly used as a primary screening test. While the sensitivity of D-dimer is comparable to Wells Criteria, it lacks specificity and positive predictive value, thus resulting in increased hospitalizations, further testing and accompanied costs and complications. Aims: Our goal was to assess utilization of D-dimer and Wells criteria in the emergency department as a screening tool for venous thromboembolism. Materials and methods: This is a retrospective chart review conducted at a community hospital. All patients who had a D-dimer test at presentation to the emergency department were included in the study. Fishcer’s Exact was used for statistical analysis. Results: Contrary to current recommendations, 15 patients (9.3%) with low Wells Score and negative D-dimer had further imaging studies. Increased use of imaging resulted in an increased cost of care and possible exposure to the procedure related complications. Conclusions: A review of the literature and our study both conclude that adherence to current guidelines for evaluation of venous thromboembolism is less than optimal. Adherence to the guidelines in evaluating these patients would have several beneficial outcomes including reducing the need for further imaging studies thus reducing healthcare costs and decreasing possible patient complications associated with such procedures. Introduction Venous thromboembolism (VTE) is a major cause of morbidity and mortality in United States [1]. It’s prevalence is one patient per thousand people per year and out of 100,000 hospital admissions, 239 are from VTE [2-4]. Current recommendations, based on cumulative data, suggest using a two-step approach of utilizing Wells Criteria (Figure 1) for its high sensitivity and D-dimer for its high negative predictive value to triage patients quickly and effectively in the emergency department [5,6]. However, D-dimer use along with pulmonary computed tomographic angiography has increased for varying reasons [7-9]. D-dimer has very low positive predictive value and can be elevated in many other conditions, thus is not specific to VTE [7-12]. The purpose of this retrospective study was to evaluate the use of guidelines for diagnosis of VTE in a community based emergency department. Methods This is an institutional review board approved retrospective study. All patients who presented to our emergency department during January through June 2010 were considered for inclusion in the study. Patient charts were reviewed by a team of physicians for D-dimer level, documentation for Wells Score, lower extremity venous ultrasound, computed tomography chest pulmonary embolism protocol, ventilation quotient scan and demographic information. If there was no Wells Score documentation in the chart, a score was calculated using available information in the medical record. Zero was assigned for any missing data needed to calculate Wells Score. Statistical analysis was done using Fisher’s Exact Test. Results During the study period 10,651 patients presented to our emergency department, 346 (3.2%) had symptoms suggestive of VTE and were screened using D-dimer testing. Sixteen of the 346 screened (4.6%) had documented thromboembolic events. Average age of the patients was 55.4 years (range of 18-96), 63% of them being females. Table 1 shows detailed demographics of the study population. The average annual rate of venous thromboembolism was 0.23% in hospitalized patients. Wells Score was not documented in any of the patients screened for VTE. Correspondence to: Rwoof A Reshi MD, FACP, MNCCS, Assistant Professor, Neurocritical Care, University of Minnesota Medical Centre, 12-155 516 Delaware St SE, Minneapolis, MN 55455, Tel: 559-697-3744; E-mail: rrreshi@gmail.com