title: Screening for pulmonary embolism with a D-dimer assay: do we still need to assess clinical probability as well?
abstract: Clinical risk stratification and D-dimer assay can be of use in excluding pulmonary embolism in patients presenting to emergency departments but many D-dimer assays exist and their accuracy varies. We used clinical risk stratification combined with a quantitative latex-agglutination D-dimer assay to screen patients before arranging further imaging if required. Retrospective analysis of a sequential series of 376 patients revealed that no patient with a D-dimer of <275 ng/mL was diagnosed with pulmonary embolism, irrespective of clinical probability. We conclude that a latex-agglutination assay could be used to exclude pulmonary embolism without the necessity for clinical risk stratification. If these findings are borne out by further work, D-dimer strategies to exclude pulmonary embolism could substantially reduce imaging workload.
authors.affiliation: Department of Accident and Emergency, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK. doctorhammond@ntlworld.com
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hammond
authors.forename: Tajek B
authors.initials: TB
authors.lastname: Hassan
mesh_terms: D001331:Automation; D004739:England; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006300:Health Services Misuse; D006801:Humans; D007841:Latex Fixation Tests / Q000592:standards; D011655:Pulmonary Embolism / Q000175:diagnosis*; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D016526:Workload
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D