Raising the D-dimer threshold for ruling out pulmonary embolism: A single-site, observational study with a historical comparison
Banks, Colin, Gangathimmaiah, Vinay, Emeto, Theophilus, Jones, Leonie, and Furyk, Jeremy (2023) Raising the D-dimer threshold for ruling out pulmonary embolism: A single-site, observational study with a historical comparison. Emergency Medicine Australasia, 35 (2). pp. 200-204.
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Abstract
Objective: The objective of this study was to assess the impact of introduction of a new pulmonary embolism (PE) diagnostic guideline with a raised D-dimer threshold.
Methods: This is a single-site, observational, cohort study with a historical comparison. The new guideline raised the D-dimer threshold to 1000 ng/mL for most patients with a Wells' score of 4 or less. Patients investigated for PE with a D-dimer level and/or definitive imaging in 6-month periods before and after the introduction of the guideline were eligible. Patients with D-dimers of 500–1000 ng/mL were prospectively followed up at 3 months for missed PE.
Results: During the pre-intervention period, 688 patients were investigated for PE, 366 (53.2%) received definitive imaging and 39 PE were diagnosed (5.7% overall, 10.7% of those imaged). For the 121 patients with D-dimers ≥500 and <1000 ng/mL, 87 (71.9%) were imaged with 7 (5.8%) having a PE diagnosed. Post intervention there were 930 patients, of which 426 (45.8%) received definitive chest imaging and there were 50 patients with PE diagnosed (5.4% overall, 11.7% of those imaged). For the 185 patients with D-dimers ≥500 and <1000 ng/mL, 60 (32.4%) were imaged with 5 (2.7%) having PE diagnosed. No cases of missed PE were identified at 3 months.
Conclusion: The introduction of the new guideline was associated with a reduction in overall imaging rates without evidence of missed PE. Further evaluation in other settings is recommended.
Item ID: | 76119 |
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Item Type: | Article (Research - C1) |
ISSN: | 1742-6723 |
Keywords: | computed tomography pulmonary angiogram, D-dimer, emergency department, pulmonary embolism, ventilation perfusion scan |
Copyright Information: | © 2022 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
Date Deposited: | 28 Sep 2022 08:22 |
FoR Codes: | 32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320101 Cardiology (incl. cardiovascular diseases) @ 100% |
SEO Codes: | 20 HEALTH > 2001 Clinical health > 200101 Diagnosis of human diseases and conditions @ 100% |
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