title: [Value of the association of D-dimer measurement and the evaluation of clinical probability in a non-invasive diagnostic strategy of pulmonary embolism].
abstract: New diagnostic tools in suspected pulmonary embolism complete the classical diagnostic strategy of pulmonary scintigraphy and pulmonary angiography to limit the indications of these two invasive investigations. In a prospective series of 204 consecutive patients with suspected pulmonary embolism the association of D-dimer measurement and clinical probability was assessed for the exclusion of the diagnosis of pulmonary embolism. The D-DI Liatest is a new generation, unitary, rapid and quantitative latex test with a comparative diagnostic performance to that of the reference ELISA test, and well adapted to emergency situations.The clinical probability was assessed by a quantitative score based on past history, clinical symptoms and signs. The positive diagnosis of pulmonary embolism was made by spiral CT scanner and/or pulmonary angiography, associated with Duplex ultrasonography of the leg veins in nondiagnostic results. The prevalence of pulmonary embolism was 42.6% and the absence of anticoagulation in patients considered not to have pulmonary embolism was associated with a thrombo-embolic incidence of 0.9% at 3 months. Fifty-six patients had D-dimer concentrations equal or inferior to the threshold of 500 microg/L; the sensitivity was 99% and the specificity 47% with a negative predictive value of 98% to 100% in cases with a low clinical probability. D-dimer measurement is reliable and has a high cost-benefit value in ambulatory patients with suspected of pulmonary embolism and is even more valuable when the clinical probability of this diagnosis is low.
authors.affiliation: Département de cardiologie et maladies vasculaires, CHU Pontchaillou, Rennes.
authors.forename: L
authors.initials: L
authors.lastname: Palud
authors.forename: M
authors.initials: M
authors.lastname: Laurent
authors.forename: P
authors.initials: P
authors.lastname: Guéret
authors.forename: C
authors.initials: C
authors.lastname: Meunier
authors.forename: E
authors.initials: E
authors.lastname: Garin
authors.forename: P O
authors.initials: PO
authors.lastname: Benoît
authors.forename: C
authors.initials: C
authors.lastname: Belléguic
authors.forename: F
authors.initials: F
authors.lastname: Bernard du Haut Cilly
authors.forename: C
authors.initials: C
authors.lastname: Almange
authors.forename: J C
authors.initials: JC
authors.lastname: Daubert
mesh_terms: D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D