Comparison of the age-adjusted and clinical probability-adjusted D-dimer to exclude pulmonary embolism in the ED

Sharif, Sameer; Eventov, Michelle; Kearon, Clive; Parpia, Sameer; Li, Meirui; Jiang, River; Sneath, Paula; Fuentes, Carmen Otero; Marriott, Christopher; Wit, Kerstin de

doi:10.1016/j.ajem.2018.07.053

Cited by 19 publications

(12 citation statements)

References 27 publications

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“…Annually in the United States, more than 200,000 people develop venous thrombosis; of those, 50,000 cases are complicated by pulmonary embolism. [10][11][12] Pulmonary embolism (PE), a dreaded complication of DVT, occurs in up to one-third of cases and is the primary contributor to mortality. 13 Much of the morbidity of DVT results from the development of post-thrombotic syndrome, which occurs in up to 50% of patients within 2 years of DVT and encompasses a number of symptoms including leg pain, swelling, and in severe cases, venous ulcers.…”

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confidence: 99%

Clinical study of asymptomatic deep vein thrombosis in patients with varicose veins of lower extremities

2019

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Background: The main aim is to study the association between asymptomatic deep vein thrombosis (DVT) in patients with varicose veins in different gender and age groups. Secondly, to study the risk of developing DVT in patients having superficial venous thrombophlebitis (SVT) with varicose veins and finally to study the clinical correlation of clinical, etiological, anatomical and pathological (CEAP) classification with DVT in patients with varicose veins.Methods: Patients presenting to department of General surgery at SS Institute of Medical Science and Research Centre during the period from June 2017 to June 2019 with varicose veins of lower limbs and without clinical signs of DVT were included in this study. Patients were categorised according to CEAP classification. All patients were subjected to duplex scanning of lower limbs to look for presence of SVT and DVT.Results: In our study, 73% patients were males and 27% patients were females. Maximum patients were in age group of 40-60 years.16 patients had DVT, 38 patients had SVT, 166 patients belonged to C2 and 56 patients belonged to CEAP class C3 and beyond.Conclusions: There is a strong association between varicose veins and asymptomatic DVT .The presence of SVT is not a risk factor for concomitant DVT in varicose vein patients. Clinical presentation with C3 or more CEAP grade is one of the potential risk factors for concomitant DVT in varicose vein patients.

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confidence: 99%

Clinical study of asymptomatic deep vein thrombosis in patients with varicose veins of lower extremities

2019

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“…While the present study found that there was a notable difference of approximately half an hour in the length of stay between patients who had D-dimer assay and those who did not, it should be noted that our study included the patients who underwent a CT-PA scan only. The predictive value of normal Ddimer levels for exclusion of PE was over 99% and clinical probability, combined with a D-dimer assay, may thus exclude the need for further investigations and could reduce the length of stay significantly [31]. In the appropriate setting, ED physicians should, therefore, not be reluctant to request a D-dimer assay just for the sake of meeting time-based targets.…”

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confidence: 99%

Determinants of time-to-disposition in patients who underwent CT for pulmonary embolism: a retrospective study

et al. 2021

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Background Pulmonary embolism (PE) is a common life-threatening medical emergency that needs prompt diagnosis and management. Providing urgent care is a key determinant of quality in the emergency department (ED) and time-based targets have been implemented to reduce length of stay and overcrowding. The study aimed to determine factors that are associated with having a time-to-disposition of less than 4 h in patients with suspected PE who underwent computed tomography pulmonary angiography (CT-PA) to confirm the diagnosis. Methods After obtaining approval from the ethics committee, we conducted a retrospective observational study by examining CT-PA scans that was performed to rule out PE in all adult patients presenting at the ED between January 2018 and December 2019. Demographic information and clinical information, as well as arrival and disposition times were collected from electronic health records. Multivariable regression analysis was used to identify the independent factors associated with meeting the 4-h target in the ED. Results In total, the study involved 232 patients (76 men and 156 women). The median length of stay in the ED was 5.2 h and the 4-h target was achieved in 37% of patients. Multivariable logistic regression analysis revealed that a positive CT-PA scan for PE was independently associated with meeting the four-hour target in the ED (odds ratio [OR]: 2.2; 95% CI: 1.1–4.8). Furthermore, Hemoptysis was the only clinical symptom that served as an independent factor associated with meeting the 4-h target in the ED (OR: 10.4; 95% CI: 1.2–90.8). Conclusion Despite the lower number of staff and higher volume of patients on weekends, patients who presented on weekends had shorter stays and were more likely to meet the 4-h target. Careful clinical assessment, prior to requesting a CT-PA scan, is crucial, since negative CT-PA scans may be associated with failure to meet the 4-h target.

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“…In their study, Arseven et al [18] found no difference between the genders in terms of PE incidence. Sharif et al [19] examined 1075 patients diagnosed with PE in the emergency department and found that the mean age of the patients was 48 years and 69.9% were female. In the study by Dogan et al [20], 46.8% of 124 patients were female, with a mean age of 61 years.…”

Section: Discussionmentioning

confidence: 99%

The role of right ventricular volume in the diagnosis of pulmonary embolism and morbidity prediction

Türkdoğan¹,

Ertekin²,

Zencir³

et al. 2021

Journal of Surgery and Medicine

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Background/Aim: Pulmonary embolism is a quite common and usually fatal disease. This study aimed to investigate the predictive value of the right ventricular volume in terms of pulmonary embolism and its laterality using imaging techniques. Methods: This case-control study included patients who underwent tomography with a pre-diagnosis of pulmonary embolism between January 2016 and January 2018. The study group included patients diagnosed with pulmonary embolism, while the control group consisted of those with an excluded diagnosis of embolism. The gender, age, echocardiography, right ventricular volume, embolism location, computed tomography results, morbidity, and mortality of the patients were recorded. Among 253 patients who underwent chest tomography with a diagnosis of pulmonary embolism, the data of 149 patients were obtained. There were 64 individuals in the control group and 85 individuals in the patient group. Results: In the study group, the length of hospital stay was 10.0 (range, 15.0-6.0) days, the systolic blood pressure was 125.5 (28.8) mmHg, the diastolic blood pressure was 77.8 (17.8) mmHg, and the heart rate was 103.4 (28.1) min. The ROC analysis of right ventricular volume revealed 81.2% sensitivity and 67.2% specificity (AUC: 0.850; P=0.001; 95% CI 0.789-0.910; cut-off: 103.7) in showing pulmonary embolism. There was a positive correlation between right ventricular volume and D-dimer (r: +0.739, P=0.001) in the control group and no correlation between the two in the study group (r: -0.178, P=0.139). Conclusion:Measuring the right ventricular volume with the software will contribute to the treatment and referral of patients with suspected pulmonary thromboembolism who underwent chest tomography. Thus, time and financial waste can be avoided by preventing unnecessary patient transfers, and early transfer of real patients can contribute to the reduction of mortality and morbidity.

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Comparison of the age-adjusted and clinical probability-adjusted D-dimer to exclude pulmonary embolism in the ED

Cited by 19 publications

References 27 publications

Clinical study of asymptomatic deep vein thrombosis in patients with varicose veins of lower extremities

Clinical study of asymptomatic deep vein thrombosis in patients with varicose veins of lower extremities

Determinants of time-to-disposition in patients who underwent CT for pulmonary embolism: a retrospective study

The role of right ventricular volume in the diagnosis of pulmonary embolism and morbidity prediction

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