scholarly journals Utilization of serum D-dimer assays prior to computed tomography pulmonary angiography scans in the diagnosis of pulmonary embolism among emergency department physicians: a retrospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Leila Salehi ◽  
Prashant Phalpher ◽  
Hubert Yu ◽  
Jeffrey Jaskolka ◽  
Marc Ossip ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Pulmonary Embolism ◽  
Diagnostic Yield ◽  
Pulmonary Angiography ◽  
Utilization Rate ◽  
Computed Tomography Pulmonary Angiography ◽  
Individual Physician ◽  
The Impact ◽  
D Dimer

Abstract Background A variety of evidence-based algorithms and decision rules using D-Dimer testing have been proposed as instruments to allow physicians to safely rule out a pulmonary embolism (PE) in low-risk patients. Objective To describe the prevalence of D-Dimer utilization among emergency department (ED) physicians and its impact on positive yields and utilization rates of Computed Tomography Pulmonary Angiography (CTPA). Methods Data was collected on all CTPA studies ordered by ED physicians at three sites during a 2-year period. Using a chi-square test, we compared the diagnostic yield for those patients who had a D-Dimer prior to their CTPA and those who did not. Secondary analysis was done to examine the impact of D-Dimer testing prior to CTPA on individual physician diagnostic yield or utilization rate. Results A total of 2811 CTPAs were included in the analysis. Of these, 964 CTPAs (34.3%) were ordered without a D-Dimer, and 343 (18.7%) underwent a CTPA despite a negative D-Dimer. Those CTPAs preceded by a D-Dimer showed no significant difference in positive yields when compared to those ordered without a D-Dimer (9.9% versus 11.3%, p = 0.26). At the individual physician level, no statistically significant relationship was found between D-Dimer utilization and CTPA utilization rate or diagnostic yield. Conclusion This study provides evidence of suboptimal adherence to guidelines in terms of D-Dimer screening prior to CTPA, and forgoing CTPAs in patients with negative D-Dimers. However, the lack of a positive impact of D-Dimer testing on either CTPA diagnostic yield or utilization rate is indicative of issues relating to the high false-positive rates associated with D-Dimer screening.

scholarly journals CORRELATION OF D-DIMER LEVEL WITH THE PRESENCE AND SEVERITY OF PULMONARY EMBOLISM ON COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAPHY

2020 ◽  
pp. 33-34
Author(s):  
Mantavya Patel ◽  
Sanjay Paliwal ◽  
Rachit Saxena
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Early Diagnosis ◽  
Pulmonary Angiography ◽  
Clinical Suspicion ◽  
Early Prediction ◽  
Computed Tomography Pulmonary Angiography ◽  
Negative Prediction ◽  
D Dimer

Introduction: Early diagnosis of pulmonary embolism can reduce morbidity and motility. D-dimer is well known parameter having high negative prediction value. This study focused on role of D-dimer in early prediction of presence and severity of pulmonary embolism. Material and Methods: Thirty patients with clinical suspicion of pulmonary embolism along with high D-dimer value were included in this study. All selected patients underwent computed tomography pulmonary angiography assessment. D-dimer value was correlated with presence and proximity of pulmonary embolism. Results: Out of thirty selected patients 50% had pulmonary embolism on computed tomography pulmonary angiography assessment. D-dimer value correlated well with presence and proximity of pulmonary embolism. Conclusion: D-dimer value more than 4000 ng/ml had high positive prediction value (79%) in suspected clinical cases. Value more than 8000 ng/ml further improve value to nearly 100% in suspected cases.

scholarly journals An Analysis of Patients That Underwent Computed Tomography Pulmonary Angiography with the Prediagnosis of Pulmonary Embolism in the Emergency Department

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Engin Ozakin ◽  
Filiz Baloglu Kaya ◽  
Nurdan Acar ◽  
Arif Alper Cevik
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Pulmonary Angiography ◽  
Shortness Of Breath ◽  
Pathological Findings ◽  
Computed Tomography Pulmonary Angiography ◽  
Common Cause ◽  
Clinical Risks ◽  
The Relationship ◽  
D Dimer

Introduction.The purpose of this study is to analyze the frequency of other diagnoses and findings in patients that were diagnosed with or not diagnosed with PE following the CTPA in the ED and to analyze the relationship between diagnosis and D-dimer.Instrument and Method.This study involves all patients that presented to the ED that underwent CTPA with the prediagnosis of PE. The items considered in this study were their reason for presenting to the ED and pretest clinical risks for PE, D-dimer, and CTPA results.Findings.Of the 696 cases, the most common cause was shortness of breath (59.3%). The CTPA showed that 145 (20.83%) patients were suffering from PE. Among the remaining cases, 464 (66.66%) patients had pathological findings other than PE and 87 (12.5%) patients were reported as normal. The most common pathological results other than PE found in CTPA were atelectasis in 244 (39.9%) and ground glass in 165 (23.7%), as well as nonpulmonary results in 70 (10.05%) patients. The differences in D-dimer results of patients diagnosed with PE, patients diagnosed with another pathology, and patients with normal CTPA results were statistically significant (P<0.001).Conclusion.CTPA scanning, performed on the basis of assessment scoring, helps in discovering other fatal pathologies in addition to PE.

Use of Computed Tomography Pulmonary Angiography for Suspected Pulmonary Embolism in Patients with Malignancy- a Single Center Experience

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5907-5907
Author(s):  
Sravanthi Ravulapati ◽  
Cerena K Leung ◽  
Mudresh R Mehta ◽  
Kara M Christopher ◽  
Susan K. Woelich ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Pulmonary Embolism ◽  
Conflicts Of Interest ◽  
Tertiary Care ◽  
Pulmonary Angiography ◽  
Screening Tools ◽  
Intermediate Risk ◽  
Computed Tomography Pulmonary Angiography ◽  
Increased Risk

Abstract Background: Pulmonary embolism (PE) is a potentially lethal condition commonly suspected in patients with malignancy. Computed Tomography Pulmonary Angiography (CTPA) is increasingly used in the diagnosis of PE, and guidelines have incorporated various screening tools including the Modified Geneva and Wells criteria to facilitate exclusion of pulmonary embolism. There is an increased risk of venous thromboembolism in patients with active malignancy and therefore an increased suspicion in patients who present to the emergency department (ED) with concerning symptoms. Methods: This is a retrospective analysis at a single tertiary care institution. All patients initially diagnosed with an active malignancy since 2005 and underwent a CTPA between January 2010 and October 2015 were reviewed. Patients were excluded if the CTPA was performed in the setting of trauma, a history of benign malignancy, or if the diagnosis of malignancy was made subsequent to the CTPA. Data collected included patient demographics, clinical presentation, type of malignancy and treatment regimen received. The modified Geneva and Wells criteria were applied to all patients independent from the initial ED risk assessment for a PE. Results: There were 796 patient records reviewed, of which 162 patients met inclusion criteria. Out of these 162 patients, only 8 (4.9%) were found to have a pulmonary embolism. All patients with a positive CTPA had an intermediate risk per the Geneva criteria while only 62.5% had an intermediate risk per the Wells criteria. Of the 154 patients with a negative CTPA, 71.5% and 78.7% had an intermediate risk; 22.5% and 18.7% were classified as low risk based on Wells and Geneva criteria, respectively. The median age of patients was 59 years old, and the majority were male (58%). The most common malignancies in which a CTPA was ordered were lung cancer (27.7%) followed by breast cancer (14.9%) and prostate cancer (6.8%). Despite a negative CTPA, 82 out of 154 patients (53%) were admitted to the hospital. Conclusion: Pulmonary embolism is commonly associated with and frequently suspected in patients with active malignancy. The incidence of PE over a 5-year period in oncology patients was 5% in our emergency department. In total, 18.7% to 22.5% of patients could have avoided a CTPA if scoring was based on the Wells or Geneva criteria. Based on the review at our institution, the modified Geneva and Wells criteria are not adequate, and a new tool needs to be developed for risk stratification for the diagnosis of PE specifically in patients with active malignancy. Disclosures No relevant conflicts of interest to declare.

scholarly journals P039: Utilization of serum D-dimer assays and computed tomography pulmonary angiography (CTPA) scans in the diagnosis of pulmonary embolism among emergency department (ED) physicians

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S78-S78
Author(s):  
L. Salehi ◽  
P. Phalpher ◽  
H. Yu ◽  
M. Ossip ◽  
R. Valani ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Decision Rules ◽  
Pulmonary Angiography ◽  
Low Risk ◽  
Urgent Care ◽  
Computed Tomography Pulmonary Angiography ◽  
Risk Patients ◽  
D Dimer ◽  
Rule Out

Introduction: As the availability of Computed Tomography Pulmonary Angiography (CTPA) to rule out pulmonary embolism (PE) increases, so too does its utilization, and consequent overutilization. A variety of evidence-based algorithms and decision rules using clinical criteria and D-Dimer testing have been proposed as instruments to allow physicians to safely rule out a PE in low-risk patients. However, studies have shown mixed results with respect to both physician uptake of these decision rules and their impact on improving ordering practices among physicians. The objective of this study is to describe the prevalence of D-Dimer utilization among ED physicians and its impact on positive yield rates of CTPAs in a community setting. Methods: Data was collected on all CTPA studies ordered by ED physicians at two very high-volume community hospitals and an affiliated urgent care centre during the 2-year period between January 1, 2016 and December 31, 2017. For each CTPA, we determined if 1) a D-Dimer had been ordered prior to CTPA, if 2) the D-Dimer was positive, and if 3) the CTPA was positive for a PE. Using a chi-square test, we compared the diagnostic yield for those patients who had a D-Dimer prior to their CTPA and those who did not. Results: A total of 2,811 CTPAs were included in the analysis. Of these, 964 CTPAs (34.3%) were ordered without a D-Dimer. Of those 1,847 patients who underwent D-Dimer testing prior to the CTPA, 343 (18.7%) underwent a CTPA despite a negative D-Dimer. When compared as a group, those CTPAs preceded by a D-Dimer showed no significant difference in positive yields when compared to those CTPAs ordered without a prior D-Dimer (9.9% versus 11.3%, p = 0.26). Conclusion: The findings of this study present a complicated picture of the impact of D-Dimer utilization on CTPA ordering patterns. There is evidence of suboptimal uptake of routine D-Dimer ordering, and adherence to guidelines in terms of forgoing CTPAs in low-risk patients with negative D-Dimers. While this study design leaves unanswered the question of how many CTPAs were avoided as a result of a negative D-Dimer, the finding of a similar positive yield among those patients who had a D-Dimer ordered versus those who did not is interesting, and illustrative of the issues arising from the high false-positive rates associated with D-Dimer screening.

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