Utilization of serum D-dimer assays prior to computed tomography pulmonary angiography scans in the diagnosis of pulmonary embolism among emergency department physicians: a retrospective observational study

Salehi, Leila; Phalpher, Prashant; Yu, Hubert; Jaskolka, Jeffrey D.; Ossip, Marc; Meaney, Christopher; Valani, Rahim; Mercuri, Mathew

doi:10.1186/s12873-021-00401-x

Cited by 6 publications

(7 citation statements)

References 45 publications

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“…In an article by Kruger et al, it was reported that a low or moderate clinical probability, combined with a normal D-dimer level, can rule out PE ( 4 ). A study by Salehi et al provided evidence of suboptimal adherence to CTPA abandonment in patients who tested D-dimer-negative before CTPA was performed ( 5 ). Yang et al observed that older age (increasing every 10 years), delay from the time of injury to surgery (daily), and fibrinogen levels > 0.…”

Section: Discussionmentioning

confidence: 99%

Successful cardiopulmonary resuscitation of cardiac arrest induced by massive pulmonary embolism under general anesthesia: a case report

Cai

2023

Front. Cardiovasc. Med.

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BackgroundWhile pulmonary embolism (PE) is a common occurrence, a large life-threatening PE is not. Herein, we discuss the case of a patient with a life-threatening PE that occurred under general anesthesia.Case presentationWe present the case of a 59-year-old male patient who was at bed rest for several days due to trauma, which resulted in femoral and rib fractures and a lung contusion. The patient was scheduled for femoral fracture reduction and internal fixation under general anesthesia. After disinfection and surgical towel laying, there was a sudden occurrence of severe PE and cardiac arrest; the patient was successfully resuscitated. Computed tomography pulmonary angiography (CTPA) was performed to confirm the diagnosis, and the patient’s condition improved after thrombolytic therapy. Unfortunately, the patient’s family eventually discontinued treatment.DiscussionMassive PE frequently occurs suddenly, may endanger a patient’s life at any point in time, and cannot be diagnosed quickly on the basis of clinical manifestations. Although the vital signs fluctuate greatly and there is insufficient time to conduct more tests, some factors such as special disease history, electrocardiography, end-tidal carbon dioxide, and blood gas analysis may help us determine the preliminary diagnosis; however, the final diagnosis is made using CTPA. Current treatment options include thrombectomy, thrombolysis, and early anticoagulation, of which thrombolysis and early anticoagulation are the most feasible.ConclusionMassive PE is a life-threatening disease that requires early diagnosis and timely treatment to save patients’ lives.

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Section: Discussionmentioning

confidence: 99%

Successful cardiopulmonary resuscitation of cardiac arrest induced by massive pulmonary embolism under general anesthesia: a case report

Cai

2023

Front. Cardiovasc. Med.

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“…A significant percentage of patients who were considered to be of a low CP of PE by both independent reviewers using Well's score, the YEARS algorithm, and the revised Geneva score were subjected to CTPA (61.4%, 55%, and 20.1%, respectively), and D-dimer testing was conducted in less than half of low-CP patients. Underutilization of the validated diagnostic predictive tools and D-dimer and overuse of CTPA are common in clinical practice [22][23][24]. Retrospective studies have reported the use of a clinical predictive tool in only 15-60% of patients with suspected PE [22,23,25,26].…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Utilization of Validated Diagnostic Predictive Tools and D-Dimer in the Evaluation of Pulmonary Embolism: A Single-Center Retrospective Cohort Study from a Public Hospital in New York City

Kharawala,

Seo,

Barzallo

et al. 2023

JCM

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Introduction: A significant increase in the use of computed tomography with pulmonary angiography (CTPA) for the diagnosis of pulmonary embolism (PE) has been observed in the past twenty years. We aimed to investigate whether the validated diagnostic predictive tools and D-dimers were adequately utilized in a large public hospital in New York City. Methods: We conducted a retrospective review of patients who underwent CTPA for the specific indication of ruling out PE over a period of one year. Two independent reviewers, blinded to each other and to the CTPA and D-dimer results, estimated the clinical probability (CP) of PE using Well’s score, the YEARS algorithm, and the revised Geneva score. Patients were classified based on the presence or absence of PE in the CTPA. Results: A total of 917 patients were included in the analysis (median age: 57 years, female: 59%). The clinical probability of PE was considered low by both independent reviewers in 563 (61.4%), 487 (55%), and 184 (20.1%) patients based on Well’s score, the YEARS algorithm, and the revised Geneva score, respectively. D-dimer testing was conducted in less than half of the patients who were deemed to have low CP for PE by both independent reviewers. Using a D-dimer cut-off of <500 ng/mL or the age-adjusted cut-off in patients with a low CP of PE would have missed only a small number of mainly subsegmental PE. All three tools, when combined with D-dimer < 500 ng/mL or <age-adjusted cut-off, yielded a NPV of > 95%. Conclusion: All three validated diagnostic predictive tools were found to have significant diagnostic value in ruling out PE when combined with a D-dimer cut-off of <500 ng/mL or the age-adjusted cut-off. Excessive use of CTPA was likely secondary to suboptimal use of diagnostic predictive tools.

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“…However, the d-dimer test showed a sensitivity of 95.7% and a specificity of 40% [ 1 , 16 ]. Another study that aimed to estimate the prevalence of d-dimer utilization in the ER revealed that there was a lack of adherence to the guidelines in terms of d-dimer testing before imaging with CT pulmonary angiography [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Early Diagnosis of Pulmonary Embolism Related to Clinical Presentation and Vital Signs in the Emergency Department at King Saud Medical City

Khan¹,

Alharbi²,

Alshehri³

et al. 2022

Cureus

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Background: Pulmonary embolism (PE) is a common acute life-threatening cardiovascular disorder. It is the third most common cause of hospital-related death and early detection and management of PE are crucial. The study aimed to evaluate the association between vital signs and laboratory investigations with PE.Methods: This is a retrospective, hospital records-based, observational study, conducted among patients who were admitted to the emergency department of King Saud Medical City in Riyadh, Saudi Arabia with a suspected diagnosis of PE during the period of March 2021 to March 2022. Data were collected by searching patients' files and recording demographic data, and information about the clinical presentation, workup, and outcome. Data were entered and analyzed using SPSS version 26 (IBM, Armonk, NY), utilizing Chi-square statistics to test differences between groups, and logistic regression analyses to identify predictors of PE.Results: The study included 92 patients, with a preponderance of females (70.7%), and those aged 40-60 years (51.1%). Diabetes mellitus (44.6%), and hypertension (30.4%) were the most common comorbidities among others, while shortness of breath (SOB) (83.7%), and chest pain (44.6%) were among the most commonly reported symptoms. A majority of patients had tachycardia (64.1%), while about half had low oxygen saturation (51.5%), and nearly one-third had tachypnea (29.3%), which was more predominant among those not diagnosed with PE. Logistic regression analysis revealed that SOB, respiratory rate, and oxygen saturation were the only significant predictors of PE. Conclusion:Although being an integral part of the initial assessment in the hospital, measuring the vital signs is not always reflective of the likelihood of PE, and they should not be the only metric relied upon to make decisions about treatment approaches in patients with PE. Physicians should ensure the employment of evidence-based clinical prediction rules and guidelines when diagnosing and managing PE.

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Utilization of serum D-dimer assays prior to computed tomography pulmonary angiography scans in the diagnosis of pulmonary embolism among emergency department physicians: a retrospective observational study

Cited by 6 publications

References 45 publications

Successful cardiopulmonary resuscitation of cardiac arrest induced by massive pulmonary embolism under general anesthesia: a case report

Successful cardiopulmonary resuscitation of cardiac arrest induced by massive pulmonary embolism under general anesthesia: a case report

Assessment of the Utilization of Validated Diagnostic Predictive Tools and D-Dimer in the Evaluation of Pulmonary Embolism: A Single-Center Retrospective Cohort Study from a Public Hospital in New York City

Early Diagnosis of Pulmonary Embolism Related to Clinical Presentation and Vital Signs in the Emergency Department at King Saud Medical City

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