<scp>d</scp>-Dimers and Efficacy of Clinical Risk Estimation Algorithms: Sensitivity in Evaluation of Acute Pulmonary Embolism

Gupta, Rajan T.; Kakarla, R.; Kirshenbaum, Kevin J.; Tapson, Victor F.

doi:10.2214/ajr.08.2186

Cited by 44 publications

(49 citation statements)

References 40 publications

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“…Findings in one study ( 21 ) suggest that D -dimer levels should be attained in patients with low or intermediate risk for PE. Radiation exposure is a growing and important issue with CT angiographic studies (22)(23)(24)(25). The mean measured effective dose by using 64-section CT angiography is 19.9 mSv 6 1.38 per study, which is based on a phantom design ( 11 ).…”

Section: -Dimer Resultsmentioning

confidence: 99%

Pulmonary Embolism at CT Angiography: Implications for Appropriateness, Cost, and Radiation Exposure in 2003 Patients

Mamlouk¹,

vanSonnenberg²,

Gosalia³

et al. 2010

Radiology

118

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Section: -Dimer Resultsmentioning

confidence: 99%

Pulmonary Embolism at CT Angiography: Implications for Appropriateness, Cost, and Radiation Exposure in 2003 Patients

Mamlouk¹,

vanSonnenberg²,

Gosalia³

et al. 2010

Radiology

118

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“…Moreover, D-dimer was the most sensitive biomarker for APE, with 85.1% sensitivity and 78.8% negative predictive value. Although D-dimer values may be used to exclude PE in patients with either a low or a moderate probability of PE, measurement of D-dimer is not useful for confirming PE [22][23][24][25]. Copeptin may be used to support the need for further investigations with moderate specificity and positive predictive value.…”

Section: Discussionmentioning

confidence: 99%

The diagnostic value of serum copeptin levels in an acute pulmonary embolism

et al. 2016

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D-dimer (r = 0.315, p = 0.003) and troponin I (r = 0.300, p = 0.004) and inversely correlated with arterial oxygen saturations (r = -0.533, p < 0001). When the correlation of copeptin with right ventricular dysfunction parameters was investigated, it was significantly inversely correlated with the tricuspid annular plane systolic excursion (r = -0.521, p < 0.001) and positively cor related with right to left ventricle ratio (r = 0.329, p = 0.024). Copeptin (OR 1.836, p = 0.008) (Cardiol J 2016; 23, 1: 42-50)

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“…Although D-dimers should only be applied to patients suspected of PE after assessment of pretest clinical probability (16,17), we applied the age-adjusted D-dimer strategies to all patients who received CTPA in our retrospective cohort to maximize generalizability.…”

Section: Discussionmentioning

confidence: 99%

Assessing 2 d-dimer age-adjustment strategies to optimize computed tomographic use in ED evaluation of pulmonary embolism

Gupta

Raja

et al. 2014

The American Journal of Emergency Medicine

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Study Objective Validate the sensitivity and specificity of two age adjustment strategies for D-dimer values in identifying patients at risk for pulmonary embolism (PE) compared to traditional D-dimer cutoff value (500ng/mL) to decrease inappropriate computed tomography pulmonary angiography (CTPA) utilization. Methods This institutional review board-approved, HIPAA-compliant retrospective study included all adult emergency department (ED) patients evaluated for PE over a 32-month period (1/1/11–8/30/13). Only patients undergoing CTPA and D-dimer testing were included. We used a validated natural language processing algorithm to parse CTPA radiology reports and determine presence of acute PE. Outcome measures were sensitivity and specificity of two age-adjusted D-dimer cutoffs compared to the traditional cutoff. We used chi-square tests with proportional analyses to assess differences in traditional and age-adjusted (age × 10 ng/mL) D-dimer cutoffs, adjusting both by decade and by year. Results A total 3,063 patients with suspected PE were evaluated by CTPA during the study period and 1,055 (34%) also received D-dimer testing. The specificity of age-adjusted D-dimer values was similar or higher for each age group studied compared to traditional cutoff, without significantly compromising sensitivity. Overall, had decade age-adjusted cutoffs been used, 37 CTPAs could have been avoided (19.6% of 189 patients aged >60 with Wells score ≤4); had yearly age-adjusted cutoffs been used, 52 CTPAs (18.2% of 286 patients aged >50 with Wells score ≤4) could have been avoided. Conclusion Each age-adjusted D-dimer cutoff strategy for the evaluation of PE was associated with increased specificity and statistically insignificant decreased sensitivity when compared to the traditional D-dimer cutoff value.

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d-Dimers and Efficacy of Clinical Risk Estimation Algorithms: Sensitivity in Evaluation of Acute Pulmonary Embolism

Cited by 44 publications

References 40 publications

Pulmonary Embolism at CT Angiography: Implications for Appropriateness, Cost, and Radiation Exposure in 2003 Patients

Pulmonary Embolism at CT Angiography: Implications for Appropriateness, Cost, and Radiation Exposure in 2003 Patients

The diagnostic value of serum copeptin levels in an acute pulmonary embolism

Assessing 2 d-dimer age-adjustment strategies to optimize computed tomographic use in ED evaluation of pulmonary embolism

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