Diagnostic accuracy of the D-dimer in children

Kanis, Jessica; Hall, Cassandra L.; Pike, Jonathan; Kline, Jeffrey A.

doi:10.1136/archdischild-2017-313315

Cited by 22 publications

(16 citation statements)

References 13 publications

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“…It was noted that in larger studies, the prevalence of PEs was lower when compared to our study at 35% (28)(29)(30). A study with 1177 patients had a prevalence of 17% [13].…”

Section: Discussioncontrasting

confidence: 69%

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The Use of End-Tidal CO2 as a Screening Tool in Patients with Pulmonary Embolism

2021

Eur J Respir Med

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Pulmonary Embolism (PE) is a global problem and a leading cause of cardiovascular death in the western world and a major public health problem [1,2]. The diagnosis of PE remains a challenge because of the high variability in clinical presentation complex interplay between different organs. Patients can present with chest pain, dyspnoea, haemoptysis, syncope and hypoxaemia [3,4]. Diagnosis of a PE is confirmed in <25% of patients that are clinically suspicious and the radiological investigations are essential [5,6]. Despite the low relative incidence of the disease, there is a significant rise in the number of patients undergoing unnecessary computed tomography pulmonary angiograms (CTPA) to exclude a PE. Moreover, the CTPA is the most robust predictive evidence base for adverse clinical outcomes in patients with acute PE [7,8].In most centres, patients with a high clinical suspicion of PE undergo serum D-dimer assessment as a screening test and it has a value in ruling out PE [9,10]. Treatment is initiated on those with a positive D-dimer and continuation of treatment is determined by the outcome of the CTPA scan [9]. Measurement of serum D-dimer requires venipuncture and results are not immediate [9]. CTPA scans are associated with high cost and exposure to radiation and nephrotoxic contrasts, a worrying concept

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“…It was noted that in larger studies, the prevalence of PEs was lower when compared to our study at 35% (28)(29)(30). A study with 1177 patients had a prevalence of 17% [13].…”

Section: Discussioncontrasting

confidence: 69%

“…A study with 1177 patients had a prevalence of 17% [13]. Perrier et al using a Eur J Respir Med 2021, 3:2 cut off value of 500 μg/L for D-dimer, obtained sensitivities of 99.5% and specificity of 41% (NPV 99%) [28,30]. We obtained similar values using 450 μg/L with marginally lower sensitivity (96%) but much better specificity (53%).…”

Section: Discussionsupporting

confidence: 67%

The Use of End-Tidal CO2 as a Screening Tool in Patients with Pulmonary Embolism

2021

Eur J Respir Med

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“…Although not sensitive, ECG may show unspecific alterations suggestive of PE, 28 as sinus tachycardia, an alarm sign present in most of our cases. d ‐dimer testing was reported to lack utility in the diagnosis of childhood PE 14 but, in a recent multicentric study, 29 displayed a 100% sensitivity. In our data, d ‐dimer were positive in all acute PE, and negative only in a subacute PE in an anticoagulated patient and an asymptomatic PE, also antiaggregated.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary embolism in pediatric age: A retrospective study from a tertiary center

Bragança

Gorito

Cibele

et al. 2021

Pediatric Pulmonology

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Introduction: Pediatric pulmonary embolism (PE) is rare but associated with adverse outcomes. We aimed to characterize PE cases admitted in a tertiary hospital and to evaluate sensitivity of selected PE diagnostic prediction tools.Methods: Retrospective, descriptive study of PE cases admitted from 2008 to 2020 using data collected from hospital records. Patients were grouped according to PE severity and setting (outpatients vs. inpatients). Links and correlation with demographic characteristics, risk factors, clinical presentation, management, and outcomes were analyzed. PE diagnostic prediction tools were applied.Results: Twenty-nine PE episodes occurred in 27 patients, 62.9% female, mean age 14.1 years. Most PE were central and split between massive or submassive. One was diagnosed in autopsy. Twenty outpatients, all adolescents, were admitted for classic PE symptoms; in half of them the diagnosis had been previously missed. Risk factors included contraceptives (65%), thrombophilia (35%), obesity (20%) and autoimmunity (20%). Eight inpatients, diagnosed during cardiorespiratory deterioration (n = 5), or through incidental radiological findings (n = 3), were younger and had immobilization (87.5%), complex chronic diseases (75%), infections (75%) and central venous catheter (62.5%) as risk factors. Retrospectively, D-dimer testing and adult scores performed better than pediatric scores (sensitivity 92.9%-96% vs. 85.7%-92.9%). Both pediatric scores missed a case with a positive family history.Discussion: Pediatric PE diagnosis is often delayed or missed. Development of pediatric prediction tools from validated adult scores merits being explored. We argue clinical presentation and risk factors may be different in inpatients and outpatients and propose broader reliance on family history.

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“…Differences in results may be related to the characteristics of patients included in the studies. Another pediatric study that retrospectively investigated the discriminative ability of D‐dimer levels in children with and without PE using high sensitivity and intermediate specificity assays showed D‐dimer levels to have an AUC of 0.90 and high sensitivity (1.00) with moderate specificity (0.58) at a cut‐off of 500 ng/ml FEU 25 . The study allowed a 30 day‐window from D‐dimer testing to pulmonary embolism or DVT diagnosis, so that the results would indicate the prognostic rather than the diagnostic value of D‐dimer levels.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of D‐dimers for limb deep vein thrombosis in children: A prospective study

et al. 2021

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The present study sought to evaluate the discriminative and predictive ability of D-dimer for pediatric limb DVT. Children aged 28 days-18 years requiring imaging to rule out limb DVT, as per the treating clinical team, were enrolled in the study. The outcome was ultrasound proven DVT. The D-dimer levels were obtained around the time of imaging. Receiver operating characteristic (ROC) curves and logistic regression models were used for data analyses. In total, 296 patients were enrolled between 2017-2020; 204 patients were diagnosed with DVT (DVT[+]). Median Ddimer levels were 2.3 μg/ml FEU (25th-75th percentile 0.9-3.9) among DVT(+) and 1.9 μg/ml FEU (25th-75th percentile 0.8-4.0) among DVT(À) patients (p = 0.60).The area under the ROC curve (AUC) was 0.52 (95% confidence interval [CI] 0.45-0.59). The odds ratio for D-dimer levels was 1.00 (95% CI 0.99-1.01), holding confounders constant. In a sub-group exploratory analysis including 23 patients with no underlying conditions or co-morbidities, the AUC curve was 0.90 (95% CI 0.76-1.00).In conclusion, in this prospective cohort study of consecutive children with suspected

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Diagnostic accuracy of the D-dimer in children

Cited by 22 publications

References 13 publications

The Use of End-Tidal CO2 as a Screening Tool in Patients with Pulmonary Embolism

The Use of End-Tidal CO2 as a Screening Tool in Patients with Pulmonary Embolism

Pulmonary embolism in pediatric age: A retrospective study from a tertiary center

Diagnostic value of D‐dimers for limb deep vein thrombosis in children: A prospective study

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