title: Non-high risk PE in the patients with acute or exacerbated respiratory disease: the value of the algorithm based on D-dimer evaluation and Revised Geneva Score.
abstract: BACKGROUND
  The diagnostic algorithm of non-high risk pulmonary embolism (PE) is based on probability scoring systems and plasma D-dimer (DD) assessment. The aim of the present study was to investigate the efficacy of Revised Geneva Scoring (RGS) and DD testing for the excluding of non-high risk PE, in the patients admitted to the hospital due to acute respiratory diseases.
  
  
  METHODS
  The consecutive patients, above 18 years of age, referred to the department of lung diseases, entered the study. The exclusion criteria were: the pregnancy and the suspicion of high risk PE. Plasma DD was measured with quick ELISA test, VIDAS D-dimer New, bioMerieux, France. Multislice computed tomography angiography was performed in all of the patients.
  
  
  RESULTS
  153 patients, median age 65 (19-88) years entered the study. The probability of PE was: low - in 58 patients (38%), intermediate - in 90 (59%), high - in 5 (3%). DD < 500 ng/ml was found in 12% of patients with low and intermediate probability of PE. PE was recognized in 10 out of 153 patients (7%). None of the patients with DD < 500 ng/ml was diagnosed with PE (NPV 100%). Median DD value was significantly higher in PE patients comparing to non-PE (4500 ng/ml and 1356 ng/ml respectively, p = 0.006).
  
  
  CONCLUSIONS
  In the group of the patients with acute respiratory symptoms, low or intermediate clinical probability scoring combined with normal DD had a high NPV in excluding PE. Nevertheless, such approach was not very effective, as the increased DD was noted in 88% of the examined population.
authors.affiliation: 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland. monika.szturmowicz@gmail.com.
authors.forename: Monika
authors.initials: M
authors.lastname: Szturmowicz
authors.forename: Aneta
authors.initials: A
authors.lastname: Kacprzak
authors.forename: Dorota
authors.initials: D
authors.lastname: Wyrostkiewicz
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Lewandowska
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Jędrych
authors.forename: Iwona
authors.initials: I
authors.lastname: Bartoszuk
authors.forename: Jarosław
authors.initials: J
authors.lastname: Kober
authors.forename: Barbara
authors.initials: B
authors.lastname: Burakowska
authors.forename: Inga
authors.initials: I
authors.lastname: Barańska
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Małek
authors.forename: Jan
authors.initials: J
authors.lastname: Kuś
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D003951:Diagnostic Errors / Q000517:prevention & control; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis*; D012016:Reference Values; D018570:Risk Assessment; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: d-dimer; probability assessment; pulmonary embolism; respiratory diseases