title: D-dimer levels to screen for venous thromboembolism in patients with fractures caused by high-energy injuries.
abstract: BACKGROUND
  The clinical relevance of D-dimer levels when screening for venous thromboembolism (VTE) in elderly patients with a hip fracture has been reported but has not been fully investigated in patients with fractures caused by high-energy injuries. The purpose of this study was to evaluate the usefulness and limitations of D-dimer in such patients.
  
  
  METHODS
  We enrolled 80 consecutive patients who underwent surgical treatment for fracture of the pelvis or lower extremity caused by high-energy injuries. None had received pharmacological prophylaxis for VTE. All patients underwent routine ultrasonography preoperatively and postoperatively (average 6.1 days after injury and 7.8 days after surgery). Contrast-enhanced computed tomography was performed routinely at the same time points for patients with a pelvic fracture or multiple fractures. D-dimer levels were compared in patients with and without VTE. Receiver operating characteristic (ROC) curve analysis was done and the appropriate D-dimer cutoff level determined for VTE screening.
  
  
  RESULTS
  VTE was diagnosed in 34 of the 80 patients. D-dimer levels were significantly higher in patients with VTE than without it at almost all time points preoperatively and postoperatively except in patients with an isolated lower extremity fracture. ROC curve analysis suggested moderate to high accuracy for predicting VTE in patients with a pelvic fracture or multiple fractures preoperatively and postoperatively. Cutoff levels with high sensitivity and specificity for patients with a pelvic fracture or multiple fractures were set at around 7 days after the injury and surgery.
  
  
  CONCLUSIONS
  D-dimer can be used as a VTE screening tool in patients with fractures caused by high-energy injuries. Our results suggested that D-dimer analysis to predict VTE was useful in patients with a pelvic fracture or multiple fractures. Our results also suggested that it was less useful for predicting VTE in patients with an isolated lower extremity fracture.
authors: Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan, tniikura@med.kobe-u.ac.jp.
authors: Takahiro
authors: T
authors: Niikura
authors: Yoshitada
authors: Y
authors: Sakai
authors: Sang Yang
authors: SY
authors: Lee
authors: Takashi
authors: T
authors: Iwakura
authors: Kotaro
authors: K
authors: Nishida
authors: Ryosuke
authors: R
authors: Kuroda
authors: Masahiro
authors: M
authors: Kurosaka
mesh_terms: D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000097:blood / Q000150:complications*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D054556:Venous Thromboembolism / Q000097:blood* / Q000453:epidemiology / Q000209:etiology
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D