The Effect of Changing from a Latex-agglutination D-dimer to an Enzyme-linked Immunosorbent Assay D-dimer on Emergency Physicians' Ordering Imaging Studies Practices to Evaluate for Pulmonary Embolism

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.

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D-Dimer Determination to Exclude Pulmonary Embolism: a Two-Step Approach Using Latex Assay as a Screening Tool

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648817 ◽

1994 ◽

Vol 72 (01) ◽

pp. 089-091 ◽

Cited By ~ 21

Author(s):

P de Moerloose ◽

Ph Minazio ◽

G Reber ◽

A Perrier ◽

H Bounameaux

Keyword(s):

Pulmonary Embolism ◽

Screening Tool ◽

Screening Tests ◽

Enzyme Linked Immunosorbent Assay ◽

Elisa Assay ◽

Elisa Technique ◽

Diagnostic Step ◽

D Dimer ◽

Rule Out ◽

Latex Test

SummaryD-dimer (DD), when measured by a quantitative enzyme-linked immunosorbent assay (ELISA), is a valuable test to exclude venous thromboembolism (VTE). However, DD ELISA technique is not appropriate for emergency use and the available agglutination latex assays are not sensitive enough to be used as an alternative to rule out the diagnosis of VTE. Latex assays could still be used as screening tests. We tested this hypothesis by comparing DD levels measured by ELISA and latex assays in 334 patients suspected of pulmonary embolism. All but one patient with a positive (DD ≥500 ng/ml) latex assay had DD levels higher than 500 ng/ml with the ELISA assay. Accordingly, ELISA technique could be restricted to patients with a negative result in latex assay. This two-step approach would have spared about 50% of ELISA in our cohort. In conclusion, our data indicate that a latex test can be used as a first diagnostic step to rule out pulmonary embolism provided a negative result is confirmed by ELISA and the performance of the latex assay used has been assessed properly.

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

International journal of epidemiologic research ◽

10.34172/ijer.2020.22 ◽

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.

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Comparison of latex agglutination, enzyme-linked immunosorbent assay, and indicator plants for detection of potato viruses S and X in potatoes

American Potato Journal ◽

10.1007/bf02853883 ◽

1986 ◽

Vol 63 (7) ◽

pp. 357-362 ◽

Cited By ~ 1

Author(s):

Gary D. Franc ◽

Ernest E. Banttari

Keyword(s):

Immunosorbent Assay ◽

Latex Agglutination ◽

Enzyme Linked Immunosorbent Assay ◽

Indicator Plants ◽

Potato Viruses

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Overutilisation of imaging studies for diagnosis of pulmonary embolism: are we following the guidelines?

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2018-135995 ◽

2019 ◽

Vol 95 (1126) ◽

pp. 420-424 ◽

Cited By ~ 10

Author(s):

Prajwal Dhakal ◽

Mian Harris Iftikhar ◽

Ling Wang ◽

Varunsiri Atti ◽

Sagar Panthi ◽

...

Keyword(s):

Pulmonary Embolism ◽

Imaging Study ◽

Pulmonary Angiography ◽

Imaging Studies ◽

Hospital Emergency ◽

Wells Score ◽

Observational Cohort ◽

Current Guidelines ◽

Retrospective Observational Cohort Study ◽

D Dimer

ObjectiveTo evaluate if imaging studies such as CT pulmonary angiography (CTPA) or ventilation–perfusion (V/Q) scan are ordered according to the current guidelines for the diagnosis of pulmonary embolism (PE).MethodsWe performed a retrospective observational cohort study in all adult patients who presented to the Sparrow Hospital Emergency Department from January 2014 to December 2016 and underwent CTPA or V/Q scan. We calculated the Wells’ score retrospectively, and d-dimer values were used to determine if the imaging study was justified.ResultsA total of 8449 patients underwent CTPA (93%) or V/Q scan (7%), among which 142 (1.7%) patients were diagnosed with PE. The Wells’ criteria showed low probabilities for PE in 96 % and intermediate or high probabilities in 4 % of total patients. Modified Wells’ criteria demonstrated PE unlikely in 99.6 % and PE likely in 0.4 % of total patients. D-dimer was obtained in only 37 % of patients who were unlikely to have a PE or had a low score on Wells’ criteria. Despite a low or unlikely Wells’ criteria score and normal d-dimer levels, 260 patients underwent imaging studies, and none were diagnosed with PE.ConclusionMore than 99 % of CTPA or V/Q scans were negative in our study. This suggests extraordinary overutilisation of the imaging methods. D-dimer, recommended in patients with low to moderate risk, was ordered in only one-third of patients. Much greater emphasis of current guidelines is needed to avoid inappropriate utilisation of resources without missing diagnosis of PE.

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A Comparison of Spiral Computed Tomography and Latex Agglutination D-dimer Assay in Acute Pulmonary Embolism using Pulmonary Arteriography as Gold Standard

Scandinavian Cardiovascular Journal ◽

10.1080/140174302762659111 ◽

2002 ◽

Vol 36 (6) ◽

pp. 373-377 ◽

Cited By ~ 13

Author(s):

Tage Nilsson ◽

Mårten Söderberg ◽

Gunilla Lundqvist ◽

Kerstin Cederlund ◽

Flemming Larsen ◽

...

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Gold Standard ◽

Acute Pulmonary Embolism ◽

Latex Agglutination ◽

Spiral Computed Tomography ◽

Spiral Computed ◽

Pulmonary Arteriography ◽

D Dimer

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Seroepidemiology of Toxoplasma gondii in pet dogs and cats in Beijing, China

Acta Parasitologica ◽

10.2478/s11686-008-0040-9 ◽

2008 ◽

Vol 53 (3) ◽

Cited By ~ 3

Author(s):

Jinhai Yu ◽

Jun Ding ◽

Zhaofei Xia ◽

Degui Lin ◽

Yili Li ◽

...

Keyword(s):

Toxoplasma Gondii ◽

Immunosorbent Assay ◽

Age Groups ◽

Latex Agglutination ◽

Agglutination Test ◽

Latex Agglutination Test ◽

Enzyme Linked Immunosorbent Assay ◽

Pet Dogs ◽

Significant Difference ◽

Beijing China

AbstractSera from 534 pet dogs and 335 pet cats from Beijing (China) were tested for anti-Toxoplasma gondii antibodies using an enzyme-linked immunosorbent assay or the latex agglutination test. The seropositivity by year, season, sex and age was analysed. Overall, 128 dogs (24.0%) and 50 cats (14.9%) had antibodies to T. gondii. When analysed by season, the highest seroprevalence was found in spring for dogs (31.3%) and cats (25.1%), and the differences in seroprevalence by season was statistically significant in cats (P<0.01) but not in dogs. The seroprevalence in male dogs (23.7%) and cats (15.1%) were slightly higher than their female counterparts (18.0% in dogs and 12.3% in cats). There was no obvious pattern of seropositivity or significant difference in different age groups in dogs or cats; nonetheless, a high proportion of dogs at 4 years of age were positive to T. gondii (31.8%) while cats with relatively high seropositivity rates were at 1 or 3.4 years of age (13.14%).

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