title: Ruling out clinically suspected pulmonary embolism by assessment of clinical probability and D-dimer levels: a management study.
abstract: D-dimer test combined with clinical probability assessment has been proposed as the first step in the diagnostic work-up of patients with suspected pulmonary embolism (PE). In a prospective management study we investigated the safety and efficiency of excluding PE by a normal D-dimer combined with a low or moderate clinical probability. Of the 202 study patients this combination ruled out PE in 64 (32%) patients. The 3-month thromboembolic risk in these patients was 0% (95% CI, 0.0-5.6%). The prevalence of PE in the entire cohort was 29% (59 patients), whereas in the low, moderate and high clinical probability groups this was 25%, 26% and 50%, respectively. We conclude that ruling out suspected PE by a normal D-dimer combined with a low or moderate clinical probability appears to be a safe and efficient strategy. The accuracy of the clinical probability assessment is modest.
authors.affiliation: Department of Internal Medicine, Isala clinics, location Sophia, Zwolle, The Netherlands. jl@jager-leclercq.demon.nl
authors.forename: Monique G L
authors.initials: MG
authors.lastname: Leclercq
authors.forename: Johan G
authors.initials: JG
authors.lastname: Lutisan
authors.forename: Marinus
authors.initials: M
authors.lastname: van Marwijk Kooy
authors.forename: Bart F
authors.initials: BF
authors.lastname: Kuipers
authors.forename: Ad H J
authors.initials: AH
authors.lastname: Oostdijk
authors.forename: Jef J C M
authors.initials: JJ
authors.lastname: van der Leur
authors.forename: Harry R
authors.initials: HR
authors.lastname: Büller
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D003937:Diagnosis, Differential; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011336:Probability; D011655:Pulmonary Embolism / Q000175:diagnosis*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D