Comparison of Diagnostic Accuracies in Outpatients and Hospitalized Patients of D-Dimer Testing for the Evaluation of Suspected Pulmonary Embolism

Schrecengost, John E.; LeGallo, Robin D.; Boyd, James C.; Moons, Karel G.M.; Gonias, Steven L.; Rose, Charles E.; Bruns, David E.

doi:10.1373/49.9.1483

Cited by 99 publications

(46 citation statements)

References 42 publications

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“…Additionally, previous research demonstrates that the D-dimer has good diagnostic accuracy, with an AUC around 0.8 on ROC curve analysis determined in an ED population. 8 The D-dimer has also demonstrated very high sensitivity, with comparatively moderate specificity. 9 Thus, we anticipated that markers demonstrating acceptable diagnostic accuracy in this study might also demonstrate higher specificity, but not necessarily the very high sensitivity seen with the D-dimer.…”

Section: Discussionmentioning

confidence: 99%

“…9 Thus, we anticipated that markers demonstrating acceptable diagnostic accuracy in this study might also demonstrate higher specificity, but not necessarily the very high sensitivity seen with the D-dimer. 10 Based on an estimated VTE prevalence between 5 and 10%, 8,9 we determined that a minimum of 200 patients would be required to distinguish a difference in AUC of 0.5 and 0.7 at the 95% confidence level. 7 …”

Section: Discussionmentioning

confidence: 99%

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Direct Comparison of the Diagnostic Accuracy of Fifty Protein Biological Markers of Pulmonary Embolism for Use in the Emergency Department

Nordenholz

Mitchell

Kline

2008

Academic Emergency Medicine

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Objectives: Pulmonary embolism (PE) is associated with abnormal concentrations of many proteins involved in inflammation, hemostasis, and vascular injury. The authors quantified the diagnostic accuracy of a battery of protein biological markers for the detection of PE in emergency department (ED) patients.Methods: A random and a consecutive sample of ED patients evaluated for PE were prospectively enrolled at two academic EDs between August 2005 and April 2006. A plasma sample was obtained at enrollment, and all patients were followed by telephone and medical record review at 90 days for the development of venous thromboembolism (VTE) defined as PE or deep venous thrombosis (DVT), requiring the consensus of two of three blinded physician reviewers. Measurements of potential biological markers were performed by technicians blinded to the study objectives. The diagnostic accuracy of each biological marker was determined by the area under the receiver operating characteristic (ROC) curve.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Direct Comparison of the Diagnostic Accuracy of Fifty Protein Biological Markers of Pulmonary Embolism for Use in the Emergency Department

Nordenholz

Mitchell

Kline

2008

Academic Emergency Medicine

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“…D-Dimer estimation along with application of clinical decision rules is now a standard practice adopted for the diagnosis of deep vein thrombosis and pulmonary embolism. [10][11][12] D-Dimer is also used for the diagnosis of other fibrinolytic states like DIC. 13 The aim of this study is to evaluate the D-Dimer as a screening tool for the diagnosis of cerebral venous thrombosis.…”

Section: Introductionmentioning

confidence: 99%

Study of Cerebral Venous Trombosis in Central India

Nandmer¹

2017

jmscr

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“…The referential diagnostic pathway includes a clinical approach with the Wells [8,9] or the Revised Geneva [10] scores, the use of D-dimer [11][12][13] and, eventually, a Computed Tomography (CT) [7].…”

Section: Introductionmentioning

confidence: 99%

Usefulness of Clinical Pre-test Scores for a Correct Diagnostic Pathway in Patients with Suspected Pulmonary Embolism in Emergency Room

Luperto¹,

Villa²,

Marino³

et al. 2013

TOEMJ

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Abstract:Background: Pulmonary Embolism (PE) is a disease characterized by not specific signs and symptoms. In Italy, there are about 65,000 cases per year; mortality is about 30% if PE is not identified and decreases to 2-8% if PE is recognized and treated. International guidelines include several strategies for diagnosing the disease with confidence. The diagnostic pathway includes a clinical approach with the Wells and Revised Geneva scores, the use of D-dimer and, eventually, a Computed Tomography (CT). The CT seems to be the ideal investigation to confirm or exclude PE but it is not free from complications. Sometimes in medical practice clinicians tend to order CT more frequently than necessary, reflecting a defensive behavior instead of an evidence based behavior. This practice exposes patients to some risks, especially for kidney.Objective: To identify the efficiency of the use of clinical scores and diagnostic algorithms following the latest guidelines in patients with suspicion of PE. To analyze how many CTs could be avoided using the right approach and to evaluate the importance of any clinical variable. Eventually, to apply the two scores together (Wells score and Revised Geneva score). Methods and Materials:A retrospective, single centre, cohort study was performed from January 2011 to April 2012. All patients who made a CT in the Emergency Room for suspicion of PE were collected and classified in two groups: PEand PE +. In all patients Wells Score and Revised Geneva Score were calculated.Results: 111 patients (64% female; mean age 72±16 years) were studied. There were no differences in anamnestic, clinical and laboratory variables between the two groups. With the classic pathway 6 patients could have been safely ruled out without performing a CT. With the Wells score one PE+ patient had a low pre-test probability; with the Revised Geneva score actually 7 PE+ patients had a low pre-test probability. These results were source of doubt about the reliability of the scores. So we tried to use the two scores together, and we achieved these results: in 7 patients PE could have been safely excluded without even using CT scan. Conclusions:The study focuses on the clinical approach to PE. The clinical scores proposed by guidelines (Wells score and Revised Geneva score) are unreliable if used alone, out of a pathway. We propose to the application of the two score together to exclude PE safely without performing CT when not necessary.

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Comparison of Diagnostic Accuracies in Outpatients and Hospitalized Patients of D-Dimer Testing for the Evaluation of Suspected Pulmonary Embolism

Cited by 99 publications

References 42 publications

Direct Comparison of the Diagnostic Accuracy of Fifty Protein Biological Markers of Pulmonary Embolism for Use in the Emergency Department

Direct Comparison of the Diagnostic Accuracy of Fifty Protein Biological Markers of Pulmonary Embolism for Use in the Emergency Department

Study of Cerebral Venous Trombosis in Central India

Usefulness of Clinical Pre-test Scores for a Correct Diagnostic Pathway in Patients with Suspected Pulmonary Embolism in Emergency Room

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