title: Inappropriate use of D-dimer assay and pulmonary CT angiography in the evaluation of suspected acute pulmonary embolism.
abstract: The authors question whether the d-dimer assay and pulmonary computed tomography angiography (CTA) are being used appropriately to evaluate suspected acute pulmonary embolism (PE) at their hospital. To answer this question, a retrospective review was performed on all emergency department (ED) patients who underwent d-dimer assay and/or CTA from August 15, 2008, to August 14, 2009. The authors' algorithm for diagnosing PE requires that patients with low or intermediate probability of acute PE undergo a d-dimer assay, followed by CTA if the d-dimer is positive. Patients with high probability of PE should have CTA performed without a d-dimer assay. This result suggests that d-dimer assay and CTA are used inappropriately to evaluate patients with suspected acute PE in our ED. The low threshold for initiating an evaluation for PE decreases the prevalence of PE in this population.
authors.affiliation: Good Samaritan Hospital of Maryland, Baltimore, USA. fang.yin@nih.gov
authors.forename: Fang
authors.initials: F
authors.lastname: Yin
authors.forename: Thomas
authors.initials: T
authors.lastname: Wilson
authors.forename: Albert
authors.initials: A
authors.lastname: Della Fave
authors.forename: Moira
authors.initials: M
authors.lastname: Larsen
authors.forename: Jenni
authors.initials: J
authors.lastname: Yoon
authors.forename: Binyam
authors.initials: B
authors.lastname: Nugusie
authors.forename: Howard
authors.initials: H
authors.lastname: Freeland
authors.forename: Robert Dobbin
authors.initials: RD
authors.lastname: Chow
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000792:Angiography; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products; D006745:Hospital Bed Capacity, 300 to 499; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D