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Rapid D-dimer testing and pre-test clinical probability in the exclusion of deep venous thrombosis in symptomatic outpatients.
Blood Coagul Fibrinolysis. 2001 Apr; 12(3):165-70.BC

Abstract

We assessed the performance of three rapid D-dimer tests (Auto Dimertest, VIDAS and Tinaquant) in combination with a pretest clinical probability model for deep venous thrombosis (DVT) in 106 consecutive outpatients with suspected DVT. Contrast venography or colour-coded duplex ultrasonography demonstrated the presence of DVT in 47 patients (14 distal DVT and 33 proximal DVT). First, we assessed the accuracy indices for different cut-off levels of the rapid D-dimer tests. Sensitivity was found to be 97.9-100%, negative predictive value (NPV) was 96.3-100%, and the exclusion rate was 24.5-31.1%. Next, the patients were grouped according to the pre-test clinical probability model in categories with low, moderate or high probability. In patients with a low pre-test probability, DVT would have been directly ruled out and the patients would not have undergone further investigations. In patients with a moderate probability, D-dimer testing and, in the case of a positive result, objective testing would have been performed and, in the case of a negative result, they would have been ruled out of having DVT. Patients with high probability would directly have undergone objective tests for DVT. The combination with the pre-test clinical probability model improved the exclusion rate (43.5-44.6%), whereas sensitivity (97.5-100%) and NPV (97.6-100%) remained roughly unchanged. The combination of rapid D-dimer tests with a pre-test clinical probability model may help to reduce unnecessary work-up in patients with suspected DVT.

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Authors+Show Affiliations

Fünfsinn N
Central Haematology Laboratory, University Hospital, Inselspital Bern, Switzerland.
Caliezi C
No affiliation info available
Biasiutti FD
No affiliation info available
Korte W
No affiliation info available
Z'Brun A
No affiliation info available
Baumgartner I
No affiliation info available
Ulrich M
No affiliation info available
Cottier C
No affiliation info available
Lämmle B
No affiliation info available
Wuillemin WA
No affiliation info available

MeSH

AdolescentAdultAgedAged, 80 and overFemaleFibrin Fibrinogen Degradation ProductsHumansMaleMiddle AgedOutpatientsPhlebographyPredictive Value of TestsPrevalenceProspective StudiesRisk FactorsSensitivity and SpecificityThrombophlebitisTime FactorsUltrasonography, Doppler, ColorUltrasonography, Doppler, Duplex

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

11414629

Citation

Fünfsinn, N, et al. "Rapid D-dimer Testing and Pre-test Clinical Probability in the Exclusion of Deep Venous Thrombosis in Symptomatic Outpatients." Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis, vol. 12, no. 3, 2001, pp. 165-70.
Fünfsinn N, Caliezi C, Biasiutti FD, et al. Rapid D-dimer testing and pre-test clinical probability in the exclusion of deep venous thrombosis in symptomatic outpatients. Blood Coagul Fibrinolysis. 2001;12(3):165-70.
Fünfsinn, N., Caliezi, C., Biasiutti, F. D., Korte, W., Z'Brun, A., Baumgartner, I., Ulrich, M., Cottier, C., Lämmle, B., & Wuillemin, W. A. (2001). Rapid D-dimer testing and pre-test clinical probability in the exclusion of deep venous thrombosis in symptomatic outpatients. Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis, 12(3), 165-70.
Fünfsinn N, et al. Rapid D-dimer Testing and Pre-test Clinical Probability in the Exclusion of Deep Venous Thrombosis in Symptomatic Outpatients. Blood Coagul Fibrinolysis. 2001;12(3):165-70. PubMed PMID: 11414629.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rapid D-dimer testing and pre-test clinical probability in the exclusion of deep venous thrombosis in symptomatic outpatients. AU - Fünfsinn,N, AU - Caliezi,C, AU - Biasiutti,F D, AU - Korte,W, AU - Z'Brun,A, AU - Baumgartner,I, AU - Ulrich,M, AU - Cottier,C, AU - Lämmle,B, AU - Wuillemin,W A, PY - 2001/6/21/pubmed PY - 2002/1/5/medline PY - 2001/6/21/entrez SP - 165 EP - 70 JF - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JO - Blood Coagul Fibrinolysis VL - 12 IS - 3 N2 - We assessed the performance of three rapid D-dimer tests (Auto Dimertest, VIDAS and Tinaquant) in combination with a pretest clinical probability model for deep venous thrombosis (DVT) in 106 consecutive outpatients with suspected DVT. Contrast venography or colour-coded duplex ultrasonography demonstrated the presence of DVT in 47 patients (14 distal DVT and 33 proximal DVT). First, we assessed the accuracy indices for different cut-off levels of the rapid D-dimer tests. Sensitivity was found to be 97.9-100%, negative predictive value (NPV) was 96.3-100%, and the exclusion rate was 24.5-31.1%. Next, the patients were grouped according to the pre-test clinical probability model in categories with low, moderate or high probability. In patients with a low pre-test probability, DVT would have been directly ruled out and the patients would not have undergone further investigations. In patients with a moderate probability, D-dimer testing and, in the case of a positive result, objective testing would have been performed and, in the case of a negative result, they would have been ruled out of having DVT. Patients with high probability would directly have undergone objective tests for DVT. The combination with the pre-test clinical probability model improved the exclusion rate (43.5-44.6%), whereas sensitivity (97.5-100%) and NPV (97.6-100%) remained roughly unchanged. The combination of rapid D-dimer tests with a pre-test clinical probability model may help to reduce unnecessary work-up in patients with suspected DVT. SN - 0957-5235 UR - https://www.unboundmedicine.com/medline/citation/11414629/Rapid_D_dimer_testing_and_pre_test_clinical_probability_in_the_exclusion_of_deep_venous_thrombosis_in_symptomatic_outpatients_ L2 - https://doi.org/10.1097/00001721-200104000-00001 DB - PRIME DP - Unbound Medicine ER -