...except, perhaps, in a risk-management sense - but, only if we keep beating it down into its narrowest application due to its terrible specificity.
This most recent Annals publishes a systematic review of the Pulmonary Embolism Rule-Out Criteria, a decision instrument recommended in ACEP's pulmonary embolism clinical guidelines as a reasonable tool to risk-stratify a patient into a so-called "zero-risk" population that does not require any testing - not even a D-dimer. And, I think they do a reasonable job including studies and summarizing the data, especially considering the width of the error bars on a lot of these studies.
The key points - pooled sensitivity is 97% when applied to a low-risk (Wells, Geneva, gestalt, whichever) population with a negative LR of 0.18. This means, if you had someone who you already didn't think had a PE and they meet PERC criteria, it helps you with your medicolegal documentation, since it's in ACEP's guidelines. The negative LR is strong enough to be helpful - but when you're already looking at single-digit percentage risk for PE, the absolute reduction in risk is quite small.
The important point to hammer home is the positive LR is only 1.23, which makes it the D-dimer of decision instruments. Please don't justify further work-up just because they fail PERC - it barely moves the needle with its terrible specificity. You need to have another clinical justification for further work-up in pulmonary embolism.
As an aside, in this era of over-testing and over-diagnosis of PE, the diagnosis of PE isn't necessarily the ideal endpoint - what we should be following are patient-oriented outcomes such as death/heart failure in untreated PE in PERC-negative patients to truly make it a valid tool.
"Diagnostic Accuracy of Pulmonary Embolism Rule-Out Criteria: A Systematic Review and Meta-analysis"