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Application of a decision rule and a D-dimer assay in the diagnosis of pulmonary embolism.
Thromb Haemost. 2010 Apr; 103(4):849-54.TH

Abstract

Current strategies for diagnosing pulmonary embolism (PE) include a clinical decision rule (CDR), followed by a D-dimer assay in patients with an unlikely clinical probability. We assessed the implementation of the current guidelines for the diagnosis of PE. A first questionnaire was sent to internists and pulmonologists to assess the proportion of physicians that adequately applied the guidelines. Two versions of a second questionnaire were sent presenting five hypothetical cases of which in two cases with an intermediate clinical probability an abnormal D-dimer test result was added to one version. We assessed the variation of the CDR and compared the proportions of a likely clinical probability between the two versions. A total of 65 physicians responded to the first questionnaire (response rate 75%). Half of the physicians (N=29; 46%) indicated that they use a CDR in all patients and 22 physicians (45%) indicated that they review the D-dimer result after they examined patients. Sixty-two physicians responded on the second questionnaire (response rate 36%). A shift was observed from an unlikely to a likely probability when an abnormal D-dimer test result was added to the clinical information (22% to 41%; p=0.22 and 26% to 50%; p<0.05). Our findings indicate that physicians do not use the guidelines for diagnosis of PE consistently. Furthermore, the knowledge of an abnormal D-dimer test result before seeing the patient leads to a higher CDR score. Physicians should therefore first examine patients before taking note of the D-dimer test result.

Authors+Show Affiliations

Department of Vascular Medicine, Academical Medical Center, Amsterdam, The Netherlands. n.s.gibson@amc.uva.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20174752

Citation

Gibson, Nadine S., et al. "Application of a Decision Rule and a D-dimer Assay in the Diagnosis of Pulmonary Embolism." Thrombosis and Haemostasis, vol. 103, no. 4, 2010, pp. 849-54.
Gibson NS, Douma RA, Squizzato A, et al. Application of a decision rule and a D-dimer assay in the diagnosis of pulmonary embolism. Thromb Haemost. 2010;103(4):849-54.
Gibson, N. S., Douma, R. A., Squizzato, A., Söhne, M., Büller, H. R., & Gerdes, V. E. (2010). Application of a decision rule and a D-dimer assay in the diagnosis of pulmonary embolism. Thrombosis and Haemostasis, 103(4), 849-54. https://doi.org/10.1160/TH08-09-0564
Gibson NS, et al. Application of a Decision Rule and a D-dimer Assay in the Diagnosis of Pulmonary Embolism. Thromb Haemost. 2010;103(4):849-54. PubMed PMID: 20174752.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Application of a decision rule and a D-dimer assay in the diagnosis of pulmonary embolism. AU - Gibson,Nadine S, AU - Douma,Renee A, AU - Squizzato,Alessandro, AU - Söhne,Maaike, AU - Büller,Harry R, AU - Gerdes,Victor E A, Y1 - 2010/02/19/ PY - 2008/09/11/received PY - 2010/02/02/accepted PY - 2010/2/23/entrez PY - 2010/2/23/pubmed PY - 2010/6/18/medline SP - 849 EP - 54 JF - Thrombosis and haemostasis JO - Thromb Haemost VL - 103 IS - 4 N2 - Current strategies for diagnosing pulmonary embolism (PE) include a clinical decision rule (CDR), followed by a D-dimer assay in patients with an unlikely clinical probability. We assessed the implementation of the current guidelines for the diagnosis of PE. A first questionnaire was sent to internists and pulmonologists to assess the proportion of physicians that adequately applied the guidelines. Two versions of a second questionnaire were sent presenting five hypothetical cases of which in two cases with an intermediate clinical probability an abnormal D-dimer test result was added to one version. We assessed the variation of the CDR and compared the proportions of a likely clinical probability between the two versions. A total of 65 physicians responded to the first questionnaire (response rate 75%). Half of the physicians (N=29; 46%) indicated that they use a CDR in all patients and 22 physicians (45%) indicated that they review the D-dimer result after they examined patients. Sixty-two physicians responded on the second questionnaire (response rate 36%). A shift was observed from an unlikely to a likely probability when an abnormal D-dimer test result was added to the clinical information (22% to 41%; p=0.22 and 26% to 50%; p<0.05). Our findings indicate that physicians do not use the guidelines for diagnosis of PE consistently. Furthermore, the knowledge of an abnormal D-dimer test result before seeing the patient leads to a higher CDR score. Physicians should therefore first examine patients before taking note of the D-dimer test result. SN - 2567-689X UR - https://www.unboundmedicine.com/medline/citation/20174752/Application_of_a_decision_rule_and_a_D_dimer_assay_in_the_diagnosis_of_pulmonary_embolism_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1160/TH08-09-0564 DB - PRIME DP - Unbound Medicine ER -