Exclusion of acute pulmonary embolism: computed tomography pulmonary angiogram or D-dimer?
Singapore Med J
; 50(4): 403-6, 2009 Apr.
Article
em En
| MEDLINE
| ID: mdl-19421686
ABSTRACT
INTRODUCTION:
The aim of our study was to determine the accuracy of the D-dimer test in the exclusion of pulmonary embolism.METHODS:
In 2006, 446 patients at our hospital underwent computed tomography pulmonary angiogram (CTPA) for the exclusion of pulmonary embolism. We selected patients with a clinical suspicion of pulmonary embolism, and who underwent both a CTPA examination and a D-dimer test performed within a period of five days. Pregnant women, patients with an allergy to intravenous contrast and those who were on anticoagulant therapy were excluded. Based on our criteria, 219 cases were selected. D-dimer test was performed using an immunoturbidimetric assay. A cut-off value of 500 ng/ml was selected as the upper limit to exclude thrombosis.RESULTS:
There were 42 patients positive for pulmonary embolism on CTPA and all had elevated D-dimer values. There were 177 patients negative for pulmonary embolism on CTPA and 49 of them had normal D-dimer values. The sensitivity and specificity of the D-dimer test was 100.0 percent (95 percent confidence interval [CI] 91.6-100.0) and 27.7 percent (95 percent CI 21.2-34.9), respectively. The likelihood ratio for a positive test and negative test was 1.38 and 0, respectively.CONCLUSION:
The D-dimer test is suitable for screening patients with a clinical suspicion of pulmonary embolism. The indiscriminate use of CTPA results in unnecessary testing and elevates healthcare costs. Clinicians are urged to give due consideration to a D-dimer test result prior to requesting a CTPA examination.
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Base de dados:
MEDLINE
Assunto principal:
Embolia Pulmonar
/
Produtos de Degradação da Fibrina e do Fibrinogênio
/
Angiografia
/
Tomografia Computadorizada por Raios X
Idioma:
En
Ano de publicação:
2009
Tipo de documento:
Article