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Does a clinical decision rule using D-dimer level improve the yield of pulmonary CT angiography?
AJR Am J Roentgenol. 2011 May; 196(5):1059-64.AA

Abstract

OBJECTIVE

The objective of our study was to evaluate the impact of incorporating a mandatory clinical decision rule and selective d-dimer use on the yield of pulmonary CT angiography (CTA).

MATERIALS AND METHODS

Guidelines incorporating a clinical decision rule (Wells score: range, 0-12.5) and a highly sensitive d-dimer assay as decision points were placed into a computerized order entry menu. From December 2006 through November 2008, 261 pulmonary CTA examinations of 238 men and 14 women (mean age ± SD, 65 ± 12 years; range, 31-92 years) were performed. Eight patients underwent more than one pulmonary CTA examination. Charts were reviewed. The results of pulmonary CTA, the clinical decision rule, and d-dimer level (if obtained) were analyzed with the Student t test, chi-square test, or other comparisons using statistical software (MedCalc, version 11.0).

RESULTS

Of the pulmonary CTA examinations, 16.5% (43/261) were positive for pulmonary embolism (PE) compared with 3.1% (6/196) during the previous 2 years. The mean clinical decision rule score and mean d-dimer level were 5.5 ± 2.4 (SD) and 4956 ± 2892 ng/mL, respectively, for those with PE compared with 4.5 ± 2.1 and 2398 ± 2100 ng/mL for those without PE (both, p < 0.01). The negative predictive value of a clinical decision rule score of 4 or less and d-dimer level of less than 1000 ng/mL was 1.0. A clinical decision rule of greater than 4 and a higher d-dimer level were better predictors for PE, especially a d-dimer level of greater than 3000 ng/mL (odds ratio = 6.69; 95% CI = 2.72-16.43).

CONCLUSION

Guidelines combining a clinical decision rule with d-dimer level significantly improved the utilization of pulmonary CTA and positive yield for PE.

Authors+Show Affiliations

Pulmonary and Critical Care Section, West Los Angeles Medical Center, CA 90073, USA. Guy.Soohoo@va.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21512071

Citation

Hoo, Guy W Soo, et al. "Does a Clinical Decision Rule Using D-dimer Level Improve the Yield of Pulmonary CT Angiography?" AJR. American Journal of Roentgenology, vol. 196, no. 5, 2011, pp. 1059-64.
Hoo GW, Wu CC, Vazirani S, et al. Does a clinical decision rule using D-dimer level improve the yield of pulmonary CT angiography? AJR Am J Roentgenol. 2011;196(5):1059-64.
Hoo, G. W., Wu, C. C., Vazirani, S., Li, Z., & Barack, B. M. (2011). Does a clinical decision rule using D-dimer level improve the yield of pulmonary CT angiography? AJR. American Journal of Roentgenology, 196(5), 1059-64. https://doi.org/10.2214/AJR.10.4200
Hoo GW, et al. Does a Clinical Decision Rule Using D-dimer Level Improve the Yield of Pulmonary CT Angiography. AJR Am J Roentgenol. 2011;196(5):1059-64. PubMed PMID: 21512071.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does a clinical decision rule using D-dimer level improve the yield of pulmonary CT angiography? AU - Hoo,Guy W Soo, AU - Wu,Carol C, AU - Vazirani,Sondra, AU - Li,Zhaoping, AU - Barack,Bruce M, PY - 2011/4/23/entrez PY - 2011/4/23/pubmed PY - 2011/6/29/medline SP - 1059 EP - 64 JF - AJR. American journal of roentgenology JO - AJR Am J Roentgenol VL - 196 IS - 5 N2 - OBJECTIVE: The objective of our study was to evaluate the impact of incorporating a mandatory clinical decision rule and selective d-dimer use on the yield of pulmonary CT angiography (CTA). MATERIALS AND METHODS: Guidelines incorporating a clinical decision rule (Wells score: range, 0-12.5) and a highly sensitive d-dimer assay as decision points were placed into a computerized order entry menu. From December 2006 through November 2008, 261 pulmonary CTA examinations of 238 men and 14 women (mean age ± SD, 65 ± 12 years; range, 31-92 years) were performed. Eight patients underwent more than one pulmonary CTA examination. Charts were reviewed. The results of pulmonary CTA, the clinical decision rule, and d-dimer level (if obtained) were analyzed with the Student t test, chi-square test, or other comparisons using statistical software (MedCalc, version 11.0). RESULTS: Of the pulmonary CTA examinations, 16.5% (43/261) were positive for pulmonary embolism (PE) compared with 3.1% (6/196) during the previous 2 years. The mean clinical decision rule score and mean d-dimer level were 5.5 ± 2.4 (SD) and 4956 ± 2892 ng/mL, respectively, for those with PE compared with 4.5 ± 2.1 and 2398 ± 2100 ng/mL for those without PE (both, p < 0.01). The negative predictive value of a clinical decision rule score of 4 or less and d-dimer level of less than 1000 ng/mL was 1.0. A clinical decision rule of greater than 4 and a higher d-dimer level were better predictors for PE, especially a d-dimer level of greater than 3000 ng/mL (odds ratio = 6.69; 95% CI = 2.72-16.43). CONCLUSION: Guidelines combining a clinical decision rule with d-dimer level significantly improved the utilization of pulmonary CTA and positive yield for PE. SN - 1546-3141 UR - https://www.unboundmedicine.com/medline/citation/21512071/Does_a_clinical_decision_rule_using_D_dimer_level_improve_the_yield_of_pulmonary_CT_angiography L2 - https://www.ajronline.org/doi/10.2214/AJR.10.4200 DB - PRIME DP - Unbound Medicine ER -