Tags

Type your tag names separated by a space and hit enter

Do emergency physicians use serum D-dimer effectively to determine the need for CT when evaluating patients for pulmonary embolism? Review of 5,344 consecutive patients.
AJR Am J Roentgenol. 2009 May; 192(5):1319-23.AA

Abstract

OBJECTIVE

The purpose of our study was to investigate whether D-dimer screening is being used effectively to determine the need for MDCT in diagnosing acute pulmonary embolism (PE) in emergency department patients.

MATERIALS AND METHODS

We performed a retrospective review of all patients who underwent D-dimer testing or MDCT in the emergency department from January 1, 2003, through October 31, 2005. A D-dimer value of > 0.43 microg/mL was considered positive. Diagnosis of PE was made on the basis of the MDCT. Clinical algorithms for diagnosing PE mandate that patients with a low clinical suspicion for PE undergo D-dimer testing, then MDCT if positive. For patients with a high clinical suspicion for PE, MDCT should be performed without D-dimer testing.

RESULTS

Of 3,716 D-dimer tests, 1,431 (39%) were positive and 2,285 (61%) were negative. MDCT was performed in 166 (7%) patients with negative D-dimer results and in 826 (58%) patients with positive D-dimer results. The prevalence of PE in patients with a high clinical suspicion and no D-dimer testing was 9% (139/1,628), which was higher than the rate of PE in the positive D-dimer group at 2% (19/826) (p < 0.0001). There was no significant difference in the prevalence of PE in the positive and negative D-dimer groups (2% vs 0.6%, respectively) (p = 0.23). The sensitivity and negative predictive value of D-dimer for PE were 95% (95% CI, 73.1-99.7%) and 99% (95% CI, 96.2-99.9%), respectively.

CONCLUSION

D-dimer screening is not used according to established diagnostic algorithms to determine the need for MDCT in diagnosing acute pulmonary embolism in our emergency department.

Authors+Show Affiliations

Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19380556

Citation

Corwin, Michael T., et al. "Do Emergency Physicians Use Serum D-dimer Effectively to Determine the Need for CT when Evaluating Patients for Pulmonary Embolism? Review of 5,344 Consecutive Patients." AJR. American Journal of Roentgenology, vol. 192, no. 5, 2009, pp. 1319-23.
Corwin MT, Donohoo JH, Partridge R, et al. Do emergency physicians use serum D-dimer effectively to determine the need for CT when evaluating patients for pulmonary embolism? Review of 5,344 consecutive patients. AJR Am J Roentgenol. 2009;192(5):1319-23.
Corwin, M. T., Donohoo, J. H., Partridge, R., Egglin, T. K., & Mayo-Smith, W. W. (2009). Do emergency physicians use serum D-dimer effectively to determine the need for CT when evaluating patients for pulmonary embolism? Review of 5,344 consecutive patients. AJR. American Journal of Roentgenology, 192(5), 1319-23. https://doi.org/10.2214/AJR.08.1346
Corwin MT, et al. Do Emergency Physicians Use Serum D-dimer Effectively to Determine the Need for CT when Evaluating Patients for Pulmonary Embolism? Review of 5,344 Consecutive Patients. AJR Am J Roentgenol. 2009;192(5):1319-23. PubMed PMID: 19380556.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Do emergency physicians use serum D-dimer effectively to determine the need for CT when evaluating patients for pulmonary embolism? Review of 5,344 consecutive patients. AU - Corwin,Michael T, AU - Donohoo,Jay H, AU - Partridge,Robert, AU - Egglin,Thomas K, AU - Mayo-Smith,William W, PY - 2009/4/22/entrez PY - 2009/4/22/pubmed PY - 2009/5/22/medline SP - 1319 EP - 23 JF - AJR. American journal of roentgenology JO - AJR Am J Roentgenol VL - 192 IS - 5 N2 - OBJECTIVE: The purpose of our study was to investigate whether D-dimer screening is being used effectively to determine the need for MDCT in diagnosing acute pulmonary embolism (PE) in emergency department patients. MATERIALS AND METHODS: We performed a retrospective review of all patients who underwent D-dimer testing or MDCT in the emergency department from January 1, 2003, through October 31, 2005. A D-dimer value of > 0.43 microg/mL was considered positive. Diagnosis of PE was made on the basis of the MDCT. Clinical algorithms for diagnosing PE mandate that patients with a low clinical suspicion for PE undergo D-dimer testing, then MDCT if positive. For patients with a high clinical suspicion for PE, MDCT should be performed without D-dimer testing. RESULTS: Of 3,716 D-dimer tests, 1,431 (39%) were positive and 2,285 (61%) were negative. MDCT was performed in 166 (7%) patients with negative D-dimer results and in 826 (58%) patients with positive D-dimer results. The prevalence of PE in patients with a high clinical suspicion and no D-dimer testing was 9% (139/1,628), which was higher than the rate of PE in the positive D-dimer group at 2% (19/826) (p < 0.0001). There was no significant difference in the prevalence of PE in the positive and negative D-dimer groups (2% vs 0.6%, respectively) (p = 0.23). The sensitivity and negative predictive value of D-dimer for PE were 95% (95% CI, 73.1-99.7%) and 99% (95% CI, 96.2-99.9%), respectively. CONCLUSION: D-dimer screening is not used according to established diagnostic algorithms to determine the need for MDCT in diagnosing acute pulmonary embolism in our emergency department. SN - 1546-3141 UR - https://www.unboundmedicine.com/medline/citation/19380556/Do_emergency_physicians_use_serum_D_dimer_effectively_to_determine_the_need_for_CT_when_evaluating_patients_for_pulmonary_embolism_Review_of_5344_consecutive_patients_ L2 - https://www.ajronline.org/doi/10.2214/AJR.08.1346 DB - PRIME DP - Unbound Medicine ER -