Pulmonary embolism (PE) is the third most common cause of cardiovascular mortality following coronary artery disease and stroke. During the past two decades, diagnosis of PE has considerably improved and is currently based mainly on noninvasive strategies including clinical probability assessment, D-dimer measurement and multidetector computed tomography (CT) angiography. Moreover, the index of clinical suspicion of PE has progressively increased, which has resulted in PE being ruled out in at least 80% of patients with suspected PE who are referred to a diagnostic centre . The prognosis of these patients without PE has been poorly studied. Indeed, even if PE has been ruled out, some problems may persist in this large subgroup of patients: (i) an alternative diagnosis is not always nor easily made with certainty; (ii) nearly one-third of these patients will undergo further contrast-enhanced CT for suspicion of a new PE during the subsequent year ; and (iii) a high 3-month all-cause mortality has been reported, ranging from 1.5%  to 21.5% . Moreover, evidence suggests that these patients might have a similar prognosis compared to patients with objectively proven PE .
The assessment of clinical probability of PE is recommended by international guidelines . The Geneva prediction score is a well-validated diagnostic rule [7, 8]. We studied whether assessment using this diagnostic rule would correlate with the prognosis of patients in whom PE has been ruled out, as some items of the score might have a prognostic value.