Cost associated with D-Dimer screening for acute aortic dissection.
BACKGROUND
D-Dimer (DD) has been described as a useful predictor of both morphologic changes in acute thoracic aortic dissection (TAD) and of TAD-associated mortality. This study analyzed the use of DD screening to screen patients with chest pain for acute (TAD) to determine if it improves diagnosis and cost effectiveness. This study also looked at the association of DD levels with diagnoses frequently seen in patients with dyspnea or chest pain.


METHODS
At the Helios Hospital, Krefeld, the authors analyzed the data of all patients (n = 1053, age (mean, SD) 62 ± 19 years, 49% males) admitted for chest pain to the nonsurgical emergency department (ED) in February 2010. Chest pain was the second most frequent symptom causing 138 (13.1%) admissions, 102 of which had DD testing (Inniovance® D-Dimer Assay, Dade Behring/Siemens, Germany). To assess the diagnostic reliability of DD testing, the sensitivity, specificity, and odds ratio, including 95% confidence interval, were estimated.


RESULTS
None of the patients admitted were found to have acute TAD. Had the authors used a computerized tomography (CT) scan to rule out TAD in every patient with chest pain, actual costs would have been euro 12,328. A restriction of CT scans to patients with elevated DD levels would have lowered costs to euro 5360. The actual costs were euro 670.30 for CT scans and euro 540.60 for DD tests. On analyzing the association with other diagnoses, both sensitivity and specificity were low, with the exception of pneumonia.


CONCLUSIONS
Owing to the low incidence of TAD, DD screening increases diagnostic efforts and costs but it remains unclear whether it would actually speed up TAD diagnosis. In a clinical setting DD did not help to discriminate other relevant diagnoses. Despite the high sensitivity of DD for aortic dissection published in the literature, the physician's clinical judgment remains paramount.
Department of Angiology, Helios Klinikum Krefeld, Krefeld, Germany.
Theodoros
T
Moysidis
Marc
M
Lohmann
Sarah
S
Lutkewitz
Guido
G
Kemmeries
Knut
K
Kröger
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology; D001013:Aorta, Thoracic / Q000473:pathology; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology; D015415:Biomarkers / Q000378:metabolism; D002637:Chest Pain / Q000175:diagnosis / Q000503:physiopathology; D003362:Cost-Benefit Analysis; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000191:economics / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000191:economics / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000379:methods
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D