Diagnostic strategy using a modified clinical decision rule and D-dimer test to rule out pulmonary embolism in elderly in- and outpatients

2005 ◽  
Vol 94 (07) ◽  
pp. 206-210 ◽  
Author(s):  
Pieter W. Kamphuisen ◽  
Patricia J. W. B. van Mierlo ◽  
Harry R. Büller ◽  
Maaike Söhne
Keyword(s):  
Pulmonary Embolism ◽  
Elderly Patients ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Diagnostic Strategy ◽  
Suspected Pulmonary Embolism ◽  
Diagnostic Challenge ◽  
Co Morbidity ◽  
D Dimer ◽  
Rule Out

SummaryExcluding or confirming pulmonary embolism remains a diagnostic challenge. In elderly patients pulmonary embolism is associated with substantial co-morbidity and mortality, and many elderly patients with suspected pulmonary embolism are inpatients. The safety and efficacy of the combination of a clinical probability (CDR) and d-dimer test in excluding pulmonary embolism in this group is unclear. We retrospectively analysed data of two prospective studies of consecutive in-and outpatients with suspected pulmonary embolism. The patients were categorized into three age groups: <65 years, 65–75 years and >75 years. The sensitivity, negative predictive value and the proportion of patients with the combination of a non-high CDR score according to Wells (≤ 4) and a normal d-dimer result were calculated for each group. In 747 consecutive patients with suspected pulmonary embolism, sensitivity and negative predictive value of a non-high CDR and a normal d-dimer result in outpatients (n=538) of all age categories (<65 years, 65–75 years and >75 years) were both 100%.These tests were, however, less reliable for inpatients(n=209), irrespective of their age (sensitivity 91% [ CI: 79–98%], negative predictive value 88 % [CI: 74–96%].The proportion of both in-and outpatients >75 years with a non-high CDR and a normal d-dimer concentration was only 14%,whereas this was 22% in patients 65–75 years and 41% among in-and outpatients <65 years, respectively. In elderly outpatients the combination of a non-high CDR and a normal d-dimer result is a safe strategy to rule out pulmonary embolism. However, in inpatients this algorithm is not reliable to safely exclude pulmonary embolism. In addition, the proportion of patients >65 years in which this strategy excludes pulmonary embolism is markedly lower compared to younger patients.

Tissue plasminogen activator as a novel diagnostic aid in acute pulmonary embolism

VASA ◽  
2014 ◽  
Vol 43 (6) ◽  
pp. 450-458 ◽  
Author(s):  
Julio Flores ◽  
Ángel García-Avello ◽  
Esther Alonso ◽  
Antonio Ruíz ◽  
Olga Navarrete ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Negative Predictive Value ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Predictive Value ◽  
Acute Pulmonary Embolism ◽  
Enzyme Linked Immunosorbent Assay ◽  
Diagnostic Utility ◽  
Tissue Plasminogen ◽  
D Dimer

Background: We evaluated the diagnostic efficacy of tissue plasminogen activator (tPA), using an enzyme-linked immunosorbent assay (ELISA) and compared it with an ELISA D-dimer (VIDAS D-dimer) in acute pulmonary embolism (PE). Patients and methods: We studied 127 consecutive outpatients with clinically suspected PE. The diagnosis of PE was based on a clinical probability pretest for PE and a strict protocol of imaging studies. A plasma sample to measure the levels of tPA and D-dimer was obtained at enrollment. Diagnostic accuracy for tPA and D-dimer was determined by the area under the receiver operating characteristic (ROC) curve. Sensitivity, specificity, predictive values, and the diagnostic utility of tPA with a cutoff of 8.5 ng/mL and D-dimer with a cutoff of 500 ng/mL, were calculated for PE diagnosis. Results: PE was confirmed in 41 patients (32 %). Areas under ROC curves were 0.86 for D-dimer and 0.71 for tPA. The sensitivity/negative predictive value for D-dimer using a cutoff of 500 ng/mL, and tPA using a cutoff of 8.5 ng/mL, were 95 % (95 % CI, 88–100 %)/95 % (95 % CI, 88–100 %) and 95 % (95 % CI, 88–100 %)/94 %), respectively. The diagnostic utility to exclude PE was 28.3 % (95 % CI, 21–37 %) for D-dimer and 24.4 % (95 % CI, 17–33 %) for tPA. Conclusions: The tPA with a cutoff of 8.5 ng/mL has a high sensitivity and negative predictive value for exclusion of PE, similar to those observed for the VIDAS D-dimer with a cutoff of 500 ng/mL, although the diagnostic utility was slightly higher for the D-dimer.

scholarly journals Performance of the Quantitative Latex Immunoturbidimetric D-dimer Assay for the Diagnosis of Acute Pulmonary Embolism at Rafik Hariri University Hospital

2020 ◽  
Vol 7 (3) ◽  
pp. 125-128
Author(s):  
Rida Salman ◽  
Mira Alsheikh ◽  
Rim Ismail
Keyword(s):  
Pulmonary Embolism ◽  
Negative Predictive Value ◽  
Ct Angiography ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Retrospective Chart Review ◽  
Latex Agglutination ◽  
University Hospital ◽  
Acute Pe ◽  
D Dimer

Background and aims: The diagnostic workup for pulmonary embolism (PE) includes D-dimer assay and computed tomographic angiography. Several D-dimer assays have been approved for PE diagnosis with different sensitivity and specificity. We aimed to study the sensitivity and specificity of the quantitative latex agglutination D-dimer assay used in a referral teaching hospital in Lebanon for the diagnosis of acute PE. Methods: Using a retrospective chart review, we studied 300 patients who had D-dimer test at Rafik Hariri University Hospital in the period between January 1, 2012 and December 31, 2013. Accordingly, 93 patients had a CT angiography after being suspected to have acute PE. A statistical table 2*2 was used to compare the results of CT angiography and D-dimer test. Results: Thirteen patients (13.97%) had PE and 60 patients (64.51%) had positive D-dimer test. Quantitative latex agglutination D-dimer assay had a sensitivity of 69%, specificity of 36%, and negative predictive value of 88%. False positive ratio was also 64%. Moreover, the receiver operating characteristic (ROC) curve was obtained with an area under the curve measuring 0.527. Conclusion: Quantitative latex agglutination D-dimer assay has a high negative predictive value; thus, it can exclude a PE diagnosis if it is associated with low clinical pretest probability.

Use of a New Monoclonal Antibody-Based Enzyme Immunoassay for Soluble Fibrin to Exclude Pulmonary Embolism

2000 ◽  
Vol 84 (09) ◽  
pp. 474-477 ◽  
Author(s):  
Bernd-Jan Sanson ◽  
Wouter de Monyé ◽  
Jeroen Lijmer ◽  
Menno Huisman ◽  
Harry Büller ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Pulmonary Embolism ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Area Under The Curve ◽  
Study Cohort ◽  
Suspected Pulmonary Embolism ◽  
Soluble Fibrin

SummaryWe prospectively evaluated the diagnostic performance of a new soluble fibrin assay in 303 consecutive patients with suspected pulmonary embolism and examined potentially useful cut-off levels at which this disease can be safely excluded. In addition, the diagnostic accuracy was calculated in the subgroups of in- and outpatients. The ROC curve of the assay in the total study cohort had an area under the curve of 0.69. The cut-off level associated with a sensitivity and negative predictive value of 100% was 20 ng/ml, but the specificity was only 4%. The cut-off level with a sensitivity of 90% was 30 ng/ml, which corresponded with a specificity and negative predictive value of 27% and 86%, respectively. The diagnostic performance was comparable in the subgroups of in- and outpatients. We conclude that the soluble fibrin assay has a low diagnostic accuracy and seems unsuitable as a screening test for the exclusion of pulmonary embolism.

Combined measurement of factor XIII and D-dimer is helpful for differential diagnosis in patients with suspected pulmonary embolism

2017 ◽  
Vol 55 (12) ◽  
Author(s):  
Ning Tang ◽  
Ziyong Sun ◽  
Dengju Li ◽  
Jun Yang ◽  
Shiyu Yin ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Pulmonary Embolism ◽  
Factor Xiii ◽  
Coagulation Factor ◽  
Suspected Pulmonary Embolism ◽  
Coronary Syndrome ◽  
Single Center Study ◽  
Wells Score ◽  
D Dimer ◽  
Rule Out

AbstractBackground:D-dimer has been used to rule out pulmonary embolism (PE). Based on previous reports of decreased concentrations of coagulation factor XIII (FXIII) in venous thromboembolism, and no change in FXIII concentration in patients with acute cardiovascular disease, we evaluated the benefit of simultaneously measuring D-dimer and FXIII concentrations for diagnosing PE.Methods:In this prospective single-center study, we enrolled 209 patients initially suspected of having PE, and measured their D-dimer and FXIII concentrations. Forty-one patients were diagnosed with PE and 168 with other final diagnoses, including acute coronary syndrome (ACS); aortic dissection (AD); spontaneous pneumothorax (SP); other respiratory, heart, digestive and nervous diseases; and uncertain diagnoses.Results:Patients with PE had significantly higher D-dimer and lower FXIII concentrations than did patients without PE. Combined D-dimer and FXIII measurements provided a higher positive predictive value (76.6%) for PE than single tests, especially in patients with Wells score >4.0 (89.3%). Specifically, patients with AD or ACS showed higher FXIII concentrations and mean platelet volumes than did patients with PE or SP, and patients with PE and AD had higher D-dimer concentrations than did other patients. At the thresholds of 69.0% for FXIII and 1.10 μg/mL for D-dimer, 123/151 patients (81.5%) with serious diseases (PE, AD, ACS and SP) were correctly distinguished.Conclusions:Combined measurement of D-dimer and FXIII helps distinguish PE from serious diseases with similar symptoms and appears to relate to increased FXIII release from active platelets in cardiovascular disease.

Clinical Evaluation of a Monoclonal Antibody-based Enzyme Immunoassay for Fibrin Degradation Products in Patients with Clinically Suspected Pulmonary Embolism

2000 ◽  
Vol 83 (06) ◽  
pp. 892-895 ◽  
Author(s):  
Wouter de Monyé ◽  
Jeroen Lijmer ◽  
Willem Nieuwenhuizen ◽  
Harry Büller ◽  
Menno Huisman ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Operating Characteristic ◽  
Degradation Products ◽  
Characteristic Curve ◽  
Suspected Pulmonary Embolism ◽  
Fibrin Degradation Products ◽  
Potential Clinical Utility ◽  
Sensitivity Specificity

SummaryWe prospectively evaluated the diagnostic accuracy of the Fibrinostika® FbDP assay in 304 consecutive patients with suspected pulmonary embolism and examined potentially useful cut-off points at which the disease can be excluded. The prevalence of pulmonary embolism was 31%. The assay generated an area under the Receiver Operating Characteristic curve of 0.79 (95% CI 0.73–0.84). A cut-off point of 0.05 µ,g/ml yielded a sensitivity, specificity, negative predictive value and an exclusion efficiency of 100% (95% CI 96–100), 5% (95% CI 2–9), 100% (95% CI 69–100) and 3% (95% CI 2–6), respectively. A clinically useful cut-off point seems to be 0.11 µ,g/ml which corresponded with a sensitivity, specificity, negative predictive value and an exclusion efficiency of 96% (95% CI 90–99), 27% (95% CI 24–28), 93% (95% CI 84–98) and 20% (95% CI 16–25), respectively. We conclude that the assay has potential clinical utility for the exclusion of pulmonary embolism, but it cannot be used as a sole test.

Effect of D-dimer testing on the diagnostic strategy of suspected pulmonary embolism: an observational study of practice patterns and costs

2000 ◽  
Vol 10 (S3) ◽  
pp. S433-S434 ◽  
Author(s):  
E. Lebrun ◽  
B. Maitre ◽  
C. Grenier-Sennelier ◽  
S. Katsahian ◽  
M. Gouault-Heilmann ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Observational Study ◽  
Practice Patterns ◽  
Diagnostic Strategy ◽  
Suspected Pulmonary Embolism ◽  
D Dimer

New Pulmonary Embolism Diagnostic Algorythm and the Thromboprophylaxis in a Hungarian Teaching Hospital.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4000-4000
Author(s):  
Miklos Egyed ◽  
Peter Zadori ◽  
Peter Rajnics ◽  
Csaba Varga ◽  
Anita Horvath ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Negative Predictive Value ◽  
Teaching Hospital ◽  
Predictive Value ◽  
Medical Records ◽  
Surgical Patients ◽  
Computer Tomograph ◽  
Vte Prophylaxis ◽  
To Receive ◽  
D Dimer

Abstract The aims of our study were to evaluate a new pulmonary embolism (PE) diagnostic algorythm and applied VTE prophylaxis. Therefore we reviewed and analysed the medical records of 507 patients with suspected PE. The patients were classified as having preventable or nonpreventable PE according to the risk and adequacy of the administered prophylaxis, or noncompliance if the indicated prophylaxis had been refused. 507 multislice computer tomograph angiography (MuCTA) were done (27 unsuccesful) with a susppected diagnosis of PE between oct.2004 and oct. 2006. From the 140 positive patients 106 were regularly controlled by physicians in different hospitals and 87 had to receive prophylaxis according to the recommendation of the ACCP 2004 guidelines. 7% of them refused it (noncompliance). 70% received inadequate prophylaxis, 23% of the patients (nonpreventable) received prophylaxis in accordance with the ACCP 2004 guidelines. Both Medical and surgical patients were in the preventable group. From the 61 preventable cases, the reason for the inadequacyof prophylaxiswas the omission of prophylaxis in 41, inadequate dose of prophylaxis in 9, inadequate lenght in 5, inadequate anticoagulant in 5 cases. MuCTA is a very useful method to diagnose PE. From the 480 evaluable suspected cases 140 patients found be positive (29%). Adherence to the prophylaxis guidelines is frightful, 70% of patients with PE for whom prophylaxis had been indicated, could have been prevented. The incidence of PE is still high despite adequate prophylaxis, which indicates that the guidelinesmay be needed to reevaluate. Quantitative d-dimer and CRP have very good negative predictive value for excluding PE.

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