This metaanalysis by Jimenez et al6 is important for clinicians as it emphasizes this concept of medical decision making that is often overlooked. The authors did confirm what others have found: an association between elevated serum troponin levels and adverse outcomes. However, they noted that neither the positive nor the negative LR of an elevated or normal troponin level in patients with acute PE is extreme enough to either (1) warrant more aggressive therapy, such as thrombolysis, or (2) send a patient home to receive outpatient therapy. Perhaps, rather than looking at the serum troponin level as a dichotomous test (as was done in the metaanalysis by Jimenez et al6), the determination of categorical levels of troponin might identify serum levels that are more useful in guiding management decisions.9 If so, troponin levels and other cardiac biomarkers (eg, the levels of N-terminal pro-brain natriuretic peptide), when used in conjunction with echocardiographic or CT angiography evidence of right ventricular strain, or with clinical prediction scores, such as the Pulmonary Embolism Severity Index (or PESI), might identify a group of patients with acute PE who will benefit from more aggressive monitoring or treatment. This, in turn, could lead to more cost-effective and safe care of these patients.