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Qualitative point-of-care D-dimer testing compared with quantitative D-dimer testing in excluding pulmonary embolism in primary care.
J Thromb Haemost. 2015 Jun; 13(6):1004-9.JT

Abstract

BACKGROUND

General practitioners can safely exclude pulmonary embolism (PE) by using the Wells PE rule combined with D-dimer testing.

OBJECTIVE

To compare the accuracy of a strategy using the Wells rule combined with either a qualitative point-of-care (POC) D-dimer test performed in primary care or a quantitative laboratory-based D-dimer test.

METHODS

We used data from a prospective cohort study including 598 adults suspected of PE in primary care in the Netherlands. General practitioners scored the Wells rule and carried out a qualitative POC test. All patients were referred to hospital for reference testing. We obtained quantitative D-dimer test results as performed in hospital laboratories. The primary outcome was the prevalence of venous thromboembolism in low-risk patients.

RESULTS

Prevalence of PE was 12.2%. POC D-dimer test results were available in 582 patients (97%). Quantitative test results were available in 401 patients (67%). We imputed results in 197 patients. The quantitative test and POC test missed one (0.4%) and four patients (1.5%), respectively, with a negative strategy (Wells ≤ 4 points and D-dimer test negative) (P = 0.20). The POC test could exclude 23 more patients (4%) (P = 0.05). The sensitivity and specificity of the Wells rule combined with a POC test were 94.5% and 51.0% and, combined with a quantitative test, 98.6% and 47.2%, respectively.

CONCLUSIONS

Combined with the Wells PE rule, both tests are safe to use in excluding PE. The quantitative test seemed to be safer than the POC test, albeit not statistically significant. The specificity of the POC test was higher, resulting in more patients in whom PE could be excluded.

Authors+Show Affiliations

Department of Family Medicine, Academic Medical Center, Amsterdam, the Netherlands.Department of Family Medicine, University of Maastricht, Maastricht, the Netherlands.Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.Department of Family Medicine, University of Maastricht, Maastricht, the Netherlands.Department of Family Medicine, Academic Medical Center, Amsterdam, the Netherlands.

Pub Type(s)

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

Language

eng

PubMed ID

25845618

Citation

Lucassen, W A M., et al. "Qualitative Point-of-care D-dimer Testing Compared With Quantitative D-dimer Testing in Excluding Pulmonary Embolism in Primary Care." Journal of Thrombosis and Haemostasis : JTH, vol. 13, no. 6, 2015, pp. 1004-9.
Lucassen WA, Erkens PM, Geersing GJ, et al. Qualitative point-of-care D-dimer testing compared with quantitative D-dimer testing in excluding pulmonary embolism in primary care. J Thromb Haemost. 2015;13(6):1004-9.
Lucassen, W. A., Erkens, P. M., Geersing, G. J., Büller, H. R., Moons, K. G., Stoffers, H. E., & van Weert, H. C. (2015). Qualitative point-of-care D-dimer testing compared with quantitative D-dimer testing in excluding pulmonary embolism in primary care. Journal of Thrombosis and Haemostasis : JTH, 13(6), 1004-9. https://doi.org/10.1111/jth.12951
Lucassen WA, et al. Qualitative Point-of-care D-dimer Testing Compared With Quantitative D-dimer Testing in Excluding Pulmonary Embolism in Primary Care. J Thromb Haemost. 2015;13(6):1004-9. PubMed PMID: 25845618.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Qualitative point-of-care D-dimer testing compared with quantitative D-dimer testing in excluding pulmonary embolism in primary care. AU - Lucassen,W A M, AU - Erkens,P M G, AU - Geersing,G J, AU - Büller,H R, AU - Moons,K G M, AU - Stoffers,H E J H, AU - van Weert,H C P M, Y1 - 2015/05/09/ PY - 2014/10/28/received PY - 2015/03/29/accepted PY - 2015/4/8/entrez PY - 2015/4/8/pubmed PY - 2016/2/26/medline KW - D-dimer KW - bedside testing KW - clinical prediction rule KW - primary healthcare KW - pulmonary embolism SP - 1004 EP - 9 JF - Journal of thrombosis and haemostasis : JTH JO - J Thromb Haemost VL - 13 IS - 6 N2 - BACKGROUND: General practitioners can safely exclude pulmonary embolism (PE) by using the Wells PE rule combined with D-dimer testing. OBJECTIVE: To compare the accuracy of a strategy using the Wells rule combined with either a qualitative point-of-care (POC) D-dimer test performed in primary care or a quantitative laboratory-based D-dimer test. METHODS: We used data from a prospective cohort study including 598 adults suspected of PE in primary care in the Netherlands. General practitioners scored the Wells rule and carried out a qualitative POC test. All patients were referred to hospital for reference testing. We obtained quantitative D-dimer test results as performed in hospital laboratories. The primary outcome was the prevalence of venous thromboembolism in low-risk patients. RESULTS: Prevalence of PE was 12.2%. POC D-dimer test results were available in 582 patients (97%). Quantitative test results were available in 401 patients (67%). We imputed results in 197 patients. The quantitative test and POC test missed one (0.4%) and four patients (1.5%), respectively, with a negative strategy (Wells ≤ 4 points and D-dimer test negative) (P = 0.20). The POC test could exclude 23 more patients (4%) (P = 0.05). The sensitivity and specificity of the Wells rule combined with a POC test were 94.5% and 51.0% and, combined with a quantitative test, 98.6% and 47.2%, respectively. CONCLUSIONS: Combined with the Wells PE rule, both tests are safe to use in excluding PE. The quantitative test seemed to be safer than the POC test, albeit not statistically significant. The specificity of the POC test was higher, resulting in more patients in whom PE could be excluded. SN - 1538-7836 UR - https://www.unboundmedicine.com/medline/citation/25845618/Qualitative_point_of_care_D_dimer_testing_compared_with_quantitative_D_dimer_testing_in_excluding_pulmonary_embolism_in_primary_care_ L2 - https://doi.org/10.1111/jth.12951 DB - PRIME DP - Unbound Medicine ER -