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Diagnostic accuracy of the Triage D-dimer test for exclusion of venous thromboembolism in outpatients.
Thromb Res. 2008; 121(6):735-41.TR

Abstract

BACKGROUND

We evaluated the diagnostic performance of the Triage D-dimer test, a new fast quantitative point-of-care whole blood D-dimer assay and compared it with the Vidas D-dimer assay.

MATERIALS AND METHODS

The study population comprised 319 outpatients for whom D-dimer testing was requested in order to rule out venous thromboembolism (VTE). Routine testing consisted of a plasma ELISA D-dimer analysis (Vidas). For all included patients, an additional EDTA whole blood D-dimer test (Triage) was performed. Patients were classified by reference imaging or by follow-up of the medical record. Accuracy indices, receiver operating characteristics and the kappa coefficient for agreement were calculated using the cutoff values recommended by the manufacturer.

RESULTS

Prevalence of VTE was 14%. Sensitivity and specificity for VTE were 98% (95%CI: 88-100) and 34% (95%CI: 28-40) for Vidas and 91% (95%CI: 78-97) and 42% (95%CI: 36-48) for Triage, respectively. The differences in sensitivity and specificity between both D-dimer assays were statistically significant (McNemar, p<0.0001). ROC-curve analysis yielded an area under the curve of 0.83 (95%CI: 0.76-0.89) for the Vidas and 0.81 (95%CI: 0.74-0.88) for the Triage (p=0.396). The kappa coefficient for agreement between Vidas and Triage was 0.75 (95%CI: 0.68-0.79).

CONCLUSIONS

The Triage and Vidas D-dimer tests show comparable diagnostic accuracy. Vidas showed a significant higher sensitivity. Our findings strongly suggest lowering the cutoff for the Triage D-dimer test from 400 to 350 ng/mL. In this way specificity lowers from 42 to 38%, but, more importantly, sensitivity increases from 91 to 95%.

Authors+Show Affiliations

Department of Hematology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium. tsghys@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article

Language

eng

PubMed ID

17888501

Citation

Ghys, Timothy, et al. "Diagnostic Accuracy of the Triage D-dimer Test for Exclusion of Venous Thromboembolism in Outpatients." Thrombosis Research, vol. 121, no. 6, 2008, pp. 735-41.
Ghys T, Achtergael W, Verschraegen I, et al. Diagnostic accuracy of the Triage D-dimer test for exclusion of venous thromboembolism in outpatients. Thromb Res. 2008;121(6):735-41.
Ghys, T., Achtergael, W., Verschraegen, I., Leus, B., & Jochmans, K. (2008). Diagnostic accuracy of the Triage D-dimer test for exclusion of venous thromboembolism in outpatients. Thrombosis Research, 121(6), 735-41.
Ghys T, et al. Diagnostic Accuracy of the Triage D-dimer Test for Exclusion of Venous Thromboembolism in Outpatients. Thromb Res. 2008;121(6):735-41. PubMed PMID: 17888501.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic accuracy of the Triage D-dimer test for exclusion of venous thromboembolism in outpatients. AU - Ghys,Timothy, AU - Achtergael,Wim, AU - Verschraegen,Inge, AU - Leus,Barbara, AU - Jochmans,Kristin, Y1 - 2007/09/20/ PY - 2007/03/05/received PY - 2007/07/05/revised PY - 2007/07/13/accepted PY - 2007/9/25/pubmed PY - 2008/10/25/medline PY - 2007/9/25/entrez SP - 735 EP - 41 JF - Thrombosis research JO - Thromb. Res. VL - 121 IS - 6 N2 - BACKGROUND: We evaluated the diagnostic performance of the Triage D-dimer test, a new fast quantitative point-of-care whole blood D-dimer assay and compared it with the Vidas D-dimer assay. MATERIALS AND METHODS: The study population comprised 319 outpatients for whom D-dimer testing was requested in order to rule out venous thromboembolism (VTE). Routine testing consisted of a plasma ELISA D-dimer analysis (Vidas). For all included patients, an additional EDTA whole blood D-dimer test (Triage) was performed. Patients were classified by reference imaging or by follow-up of the medical record. Accuracy indices, receiver operating characteristics and the kappa coefficient for agreement were calculated using the cutoff values recommended by the manufacturer. RESULTS: Prevalence of VTE was 14%. Sensitivity and specificity for VTE were 98% (95%CI: 88-100) and 34% (95%CI: 28-40) for Vidas and 91% (95%CI: 78-97) and 42% (95%CI: 36-48) for Triage, respectively. The differences in sensitivity and specificity between both D-dimer assays were statistically significant (McNemar, p<0.0001). ROC-curve analysis yielded an area under the curve of 0.83 (95%CI: 0.76-0.89) for the Vidas and 0.81 (95%CI: 0.74-0.88) for the Triage (p=0.396). The kappa coefficient for agreement between Vidas and Triage was 0.75 (95%CI: 0.68-0.79). CONCLUSIONS: The Triage and Vidas D-dimer tests show comparable diagnostic accuracy. Vidas showed a significant higher sensitivity. Our findings strongly suggest lowering the cutoff for the Triage D-dimer test from 400 to 350 ng/mL. In this way specificity lowers from 42 to 38%, but, more importantly, sensitivity increases from 91 to 95%. SN - 0049-3848 UR - https://www.unboundmedicine.com/medline/citation/17888501/Diagnostic_accuracy_of_the_Triage_D_dimer_test_for_exclusion_of_venous_thromboembolism_in_outpatients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0049-3848(07)00312-X DB - PRIME DP - Unbound Medicine ER -