title: Specificity of quantitative latex agglutination assay for D-dimer in exclusion of pulmonary embolism in the emergency department.
abstract: We assessed the prevalence of elevated quantitative latex agglutination assay for D-dimer in patients in the emergency department in whom pulmonary embolism (PE) was excluded. D-dimer was normal (<230 ng/mL) in 435 (83%) of the 522 patients. D-dimer was normal in 88% of the patients with musculoskeletal or related chest pain, 74% with pleurisy or pleuritic chest pain, and 85% with upper respiratory tract infection. D-dimer was 230 to 500 ng/mL in 65 (75%) of the 87 in whom D-dimer was elevated. Clinical probability was low in 31 (48%) of the 65 patients with D-dimer levels of 230 to 500 ng/mL. D-dimer was 230 to 500 ng/mL and clinical probability was low in 31 (36%) of the 87 patients who had computed tomographic (CT) angiograms because of elevated D-dimer. Negative likelihood ratio for PE is sufficiently low that PE can be excluded with reasonable certainty in such patients. Tailoring cutoff value to 500 ng/mL in patients with low clinical probability would have reduced CT angiograms by 36%.
authors.affiliation: Department of Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, MI, USA steinp@msu.edu.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Stein
authors.affiliation: Department of Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, MI, USA Department of Research, St Mary Mercy Hospital, Livonia, Michigan, MI, USA.
authors.forename: Fadi
authors.initials: F
authors.lastname: Matta
authors.affiliation: Department of Research, St Mary Mercy Hospital, Livonia, Michigan, MI, USA.
authors.forename: Michel J
authors.initials: MJ
authors.lastname: Sabra
authors.affiliation: Department of Emergency Medicine, St Mary Mercy Hospital, Livonia, Michigan, MI, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Tana
authors.affiliation: Department of Emergency Medicine, St Mary Mercy Hospital, Livonia, Michigan, MI, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Gough
authors.affiliation: Department of Emergency Medicine, St Mary Mercy Hospital, Livonia, Michigan, MI, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Chabala
authors.affiliation: Department of Emergency Medicine, St Mary Mercy Hospital, Livonia, Michigan, MI, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Kakish
authors.affiliation: Department of Pathology, St Mary Mercy Hospital, Livonia, Michigan, MI, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Tworek
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D007841:Latex Fixation Tests / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords:     D-dimer; pulmonary embolism; venous thromboembolism