Ruling out clinically suspected pulmonary embolism by assessment of clinical probability and D-dimer levels: a management study.
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.
Leclercq
Monique G L
MG
Department of Internal Medicine, Isala clinics, location Sophia, Zwolle, The Netherlands. jl@jager-leclercq.demon.nl
Lutisan
Johan G
JG
van Marwijk Kooy
Marinus
M
Kuipers
Bart F
BF
Oostdijk
Ad H J
AH
van der Leur
Jef J C M
JJ
Büller
Harry R
HR
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*
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D