title: Is D-dimer used according to clinical algorithms in the diagnostic work-up of patients with suspicion of venous thromboembolism? A study in six European countries.
abstract: BACKGROUND
  Clinical algorithms consisting of pre-test probability estimation and D-dimer testing are recommended in diagnostic work-up for suspected venous thromboembolism (VTE). The aim of this study was to explore how physicians working in emergency departments investigated patients suspected to have VTE.
  
  
  METHODS
  A questionnaire with two case histories related to the diagnosis of suspected pulmonary embolism (PE) (Case A) and deep venous thrombosis (DVT) (Case B) were sent to physicians in six European countries. The physicians were asked to estimate pre-test probability of VTE, and indicate their clinical actions.
  
  
  RESULTS
  In total, 487 physicians were included. Sixty percent assessed pre-test probability of PE to be high in Case A, but 7% would still request only D-dimer and 11% would exclude PE if D-dimer was negative, which could be hazardous. Besides imaging, a D-dimer test was requested by 41%, which is a "waste of resources" (extra costs and efforts, no clinical benefit). For Case B, 92% assessed pre-test probability of DVT to be low. Correctly, only D-dimer was requested by 66% of the physicians, while 26% requested imaging, alone or in addition to D-dimer, which is a "waste of resources".
  
  
  CONCLUSIONS
  These results should encourage scientific societies to improve the dissemination and knowledge of the current recommendations for the diagnosis of VTE.
authors.affiliation: Laboratory of Clinical Biochemistry, Haukeland University Hospital, Helse Bergen HF, Bergen, Norway; Norwegian Quality Improvement of Primary Care Laboratories (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway. Electronic address: ann.kristoffersen@helse-bergen.no.
authors.forename: Ann Helen
authors.initials: AH
authors.lastname: Kristoffersen
authors.affiliation: Central Laboratory, Jósa András University Hospital, Nyíregyháza, Hungary.
authors.forename: Eva
authors.initials: E
authors.lastname: Ajzner
authors.affiliation: Clinical Institute of Laboratory Diagnostics, Clinical Hospital Center Zagreb, Croatia.
authors.forename: Dunja
authors.initials: D
authors.lastname: Rogic
authors.affiliation: Department of Medical Biochemistry, Ege University, Faculty of Medicine, Izmir, Turkey.
authors.forename: Eser Y
authors.initials: EY
authors.lastname: Sozmen
authors.affiliation: Laboratory of Clinical Pathology, Department of Laboratory Medicine, Hospital Sant'Antonio, Padova, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Carraro
authors.affiliation: External Quality Assurance Unit, Department of Epidemiology, National Health Institute Dr Ricardo Jorge, Lisbon, Portugal.
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Faria
authors.affiliation: Laboratoire de Biologie Polyvalente, Centre Hospitalier La Chartreuse, Avenue Caylet, Villefranche-de-Rouergue, France.
authors.forename: Joseph
authors.initials: J
authors.lastname: Watine
authors.affiliation: ECAT Foundation, Voorschoten, the Netherlands.
authors.forename: Piet
authors.initials: P
authors.lastname: Meijer
authors.affiliation: Laboratory of Clinical Biochemistry, Haukeland University Hospital, Helse Bergen HF, Bergen, Norway; Norwegian Quality Improvement of Primary Care Laboratories (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Sverre
authors.initials: S
authors.lastname: Sandberg
mesh_terms: D000328:Adult; D000465:Algorithms; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005060:Europe; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D011336:Probability; D011655:Pulmonary Embolism / Q000175:diagnosis; D011795:Surveys and Questionnaires; D054556:Venous Thromboembolism / Q000175:diagnosis*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: Clinical algorithms; Clinical decision rules; D-dimer; Pre-test probability; Venous thromboembolism