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Excluding pulmonary embolism in primary care using the Wells-rule in combination with a point-of care D-dimer test: a scenario analysis.
BMC Fam Pract. 2010 Sep 13; 11:64.BF

Abstract

BACKGROUND

In secondary care the Wells clinical decision rule (CDR) combined with a quantitative D-dimer test can exclude pulmonary embolism (PE) safely. The introduction of point-of-care (POC) D-dimer tests facilitates a similar diagnostic strategy in primary care.We estimated failure-rate and efficiency of a diagnostic strategy using the Wells-CDR combined with a POC-D-dimer test for excluding PE in primary care.We considered ruling out PE safe if the failure rate was <2% with a maximum upper confidence limit of 2.7%.

METHODS

We performed a scenario-analysis on data of 2701 outpatients suspected of PE. We used test characteristics of two qualitative POC-D-dimer tests, as derived from a meta-analysis and combined these with the Wells-CDR-score.

RESULTS

In scenario 1 (SimpliRed-D-dimer sensitivity 85%, specificity 74%) PE was excluded safely in 23.8% of patients but only by lowering the cut-off value of the Wells rule to <2. (failure rate: 1.4%, 95% CI 0.6-2.6%)In scenario 2 (Simplify-D-dimer sensitivity 87%, specificity 62%) PE was excluded safely in 12.4% of patients provided that the Wells-cut-off value was set at 0. (failure rate: 0.9%, 95% CI 0.2-2.6%)

CONCLUSION

Theoretically a diagnostic strategy using the Wells-CDR combined with a qualitative POC-D-dimer test can be used safely to exclude PE in primary care albeit with only moderate efficiency.

Authors+Show Affiliations

Department of General Practice, Academic Medical Centre, Amsterdam, The Netherlands. w.a.lucassen@amc.uva.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20831834

Citation

Lucassen, Wim A M., et al. "Excluding Pulmonary Embolism in Primary Care Using the Wells-rule in Combination With a Point-of Care D-dimer Test: a Scenario Analysis." BMC Family Practice, vol. 11, 2010, p. 64.
Lucassen WA, Douma RA, Toll DB, et al. Excluding pulmonary embolism in primary care using the Wells-rule in combination with a point-of care D-dimer test: a scenario analysis. BMC Fam Pract. 2010;11:64.
Lucassen, W. A., Douma, R. A., Toll, D. B., Büller, H. R., & van Weert, H. C. (2010). Excluding pulmonary embolism in primary care using the Wells-rule in combination with a point-of care D-dimer test: a scenario analysis. BMC Family Practice, 11, 64. https://doi.org/10.1186/1471-2296-11-64
Lucassen WA, et al. Excluding Pulmonary Embolism in Primary Care Using the Wells-rule in Combination With a Point-of Care D-dimer Test: a Scenario Analysis. BMC Fam Pract. 2010 Sep 13;11:64. PubMed PMID: 20831834.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Excluding pulmonary embolism in primary care using the Wells-rule in combination with a point-of care D-dimer test: a scenario analysis. AU - Lucassen,Wim A M, AU - Douma,Renée A, AU - Toll,Diane B, AU - Büller,Harry R, AU - van Weert,Henk C P M, Y1 - 2010/09/13/ PY - 2010/05/10/received PY - 2010/09/13/accepted PY - 2010/9/14/entrez PY - 2010/9/14/pubmed PY - 2010/10/26/medline SP - 64 EP - 64 JF - BMC family practice JO - BMC Fam Pract VL - 11 N2 - BACKGROUND: In secondary care the Wells clinical decision rule (CDR) combined with a quantitative D-dimer test can exclude pulmonary embolism (PE) safely. The introduction of point-of-care (POC) D-dimer tests facilitates a similar diagnostic strategy in primary care.We estimated failure-rate and efficiency of a diagnostic strategy using the Wells-CDR combined with a POC-D-dimer test for excluding PE in primary care.We considered ruling out PE safe if the failure rate was <2% with a maximum upper confidence limit of 2.7%. METHODS: We performed a scenario-analysis on data of 2701 outpatients suspected of PE. We used test characteristics of two qualitative POC-D-dimer tests, as derived from a meta-analysis and combined these with the Wells-CDR-score. RESULTS: In scenario 1 (SimpliRed-D-dimer sensitivity 85%, specificity 74%) PE was excluded safely in 23.8% of patients but only by lowering the cut-off value of the Wells rule to <2. (failure rate: 1.4%, 95% CI 0.6-2.6%)In scenario 2 (Simplify-D-dimer sensitivity 87%, specificity 62%) PE was excluded safely in 12.4% of patients provided that the Wells-cut-off value was set at 0. (failure rate: 0.9%, 95% CI 0.2-2.6%) CONCLUSION: Theoretically a diagnostic strategy using the Wells-CDR combined with a qualitative POC-D-dimer test can be used safely to exclude PE in primary care albeit with only moderate efficiency. SN - 1471-2296 UR - https://www.unboundmedicine.com/medline/citation/20831834/Excluding_pulmonary_embolism_in_primary_care_using_the_Wells_rule_in_combination_with_a_point_of_care_D_dimer_test:_a_scenario_analysis_ L2 - https://bmcfampract.biomedcentral.com/articles/10.1186/1471-2296-11-64 DB - PRIME DP - Unbound Medicine ER -