Value of the D-dimer test in diagnosing deep vein thrombosis in rehabilitation inpatients.
OBJECTIVE
To assess the utility of the D-dimer test-a widely available, less costly, and less time-consuming test than others used to diagnose or exclude deep vein thrombosis (DVT) and pulmonary embolism.


METHODS
Blind comparison.


METHODS
An inpatient rehabilitation facility in Turkey.


METHODS
Sixty-eight consecutive inpatients being rehabilitated after stroke, spinal cord injury, hip arthroplasty, or traumatic brain injury.


METHODS
A latex D-dimer assay was performed on each patient at admission and then weekly throughout the hospital stay. Color Doppler ultrasonography of the lower limbs was also done for each patient at admission and was repeated when indicated by clinical signs and symptoms of DVT or by elevated D-dimer levels. Main outcome measures Patients' clinical findings, D-dimer test results, and ultrasonography results were recorded. Sensitivity, specificity, and positive and negative predictive values were calculated for the D-dimer test, each clinical finding, and combinations of D-dimer results and clinical findings in relation to DVT diagnosis.


RESULTS
The sensitivity and negative predictive value of the D-dimer test were high, at 95.2% and 96.2%, respectively. The specificity and positive predictive value were low, at 55.3% and 48.7%, respectively. No single clinical finding was reliably diagnostic for DVT.


CONCLUSIONS
The D-dimer assay is a reliable method for ruling out DVT. In the rehabilitation setting, it can be used as a routine screening test or to assess cases of suspected DVT. D-dimer testing may reduce the need for sophisticated, time-consuming, and expensive diagnostic workup of rehabilitation inpatients, a group that is at increased risk for DVT.
Akman
Mahmut Nafiz
MN
Department of Physical Medicine and Rehabilitation, Baskent University Faculty of Medicine, 5 sokak No. 48, Bahcelievler, Ayas, 06490 Ankara, Turkey. nafiza@baskent-ank.edu.tr
Cetin
Nuri
N
Bayramoglu
Meral
M
Isiklar
Iclal
I
Kilinc
Sehri
S
D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000534:rehabilitation*; D001930:Brain Injuries / Q000150:complications / Q000534:rehabilitation*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D018615:Ultrasonography, Doppler, Color; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D