A PaDd-informed, Assay-calibrated Diagnostic Pathway for Suspected Pulmonary Embolism in Older Adults: From Signal to Strategy

To the Editor: We commend Cohen et al. for introducing a prag-matic composite—Padua score × D-dimer (PaDd)—designed to refine pulmonary embolism (PE) exclusion in adults aged ≥65 years, a population often characterized by multimorbidity, physiological heterogeneity, and atypical presentations. Their single-center retrospective cohort (2021–2023) provides a compelling, hypothesis-generating signal: combining a validated venous thromboembolism risk score with D-dimer may enhance specificity without compromising safety.