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Objectives: A prospective outcome study designed to evaluate a simple strategy for the management of outpatients with suspected pulmonary embolism (PE), based on clinical probability, D‐dimer, and multi‐slice computed tomography (MSCT). Methods: A cohort of 432 consecutive patients admitted to the emergency department with suspected PE was managed by sequential non‐invasive testing. Patients in whom PE was ruled out were not given anticoagulants, but were followed‐up for 3 months. Results: Normal D‐dimer and low‐intermediate clinical probability ruled out PE in 103 patients [24% (95% CI 20–28)]. Seventeen patients had normal D‐dimer, but high clinical probability and proceeded to MSCT. All patients proved negative for PE. A total of 329 (76%) patients underwent MSCT examination. Pulmonary embolism was diagnosed in 93 patients [21.5% (95% CI 18–26)] and was ruled out by negative …