Prospective Study of the Diagnostic Accuracy of the Simplify D-dimer Assay for Pulmonary Embolism in Emergency Department Patients

Background: Pulmonary embolism is the lethal condition that is associated with higher rate of mortality in cardia patients. The diagnosis of the acute pulmonary embolism is frequently observed in patients presenting in emergency department or during hospitalization. Level of D-dimer may be assessed by blood test to help the physicians to diagnose the thrombosis. Literature showed variable evidence regarding predictive accuracy of D-dimer for detection of pulmonary embolism. So to get local data, we conducted this study. Aim: To determine the diagnostic accuracy of D-dimer assay for detection of pulmonary embolism in patients of acute myocardial infarction presenting in emergency department taking CTPA as gold standard Methods: Cross - sectional study conducted in Cardiology Department , Punjab Institute of Cardiology, Lahore for a period of six months from 1-9-2018 to 1-3-2019. One hundred patients, fulfilled the selection criteria were enrolled from emergency. Then blood sample was taken for evaluation of D-dimer level. Reports were checked and D-dimer level was noted. Pulmonary embolism was labeled as positive on D-dimer, if D-dimer level ≥500 and was labeled as negative if D-dimer level <500. Then all patients underwent CTPA. Pulmonary embolism labeled as positive if there was mass filling defects detected as dark spot on angiogram. All the data was collected by using the proforma. Data analysis as done in SPSS v. 21. Results: The mean age of patients was 54.03±10.26years. There were 40 (40) males and 60 (60%) females. The mean BMI of patients was 27.57±4.35kg/m2. There were 46 (46%) patients with diabetes mellitus while 61 (61%) patients had hypertension. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of D-dimer were 82.6%, 72.2%, 71.7%, 83.0% and 77.0%, respectively taking CTPA as gold standard. Conclusion: Thus the D-dimer is accurate enough that it can help to predict pulmonary embolism and can help to prevent at least negative cases to undergo CTPA. Keywords: Acute myocardial infarction, pulmonary embolism, D-dimer, computed tomography pulmonary angiography

Download Full-text

Normal D-dimer levels in emergency department patients suspected of acute pulmonary embolism

ACC Current Journal Review ◽

10.1016/s1062-1458(02)01004-8 ◽

2003 ◽

Vol 12 (1) ◽

pp. 17-18

Author(s):

K.L. Dunn ◽

J.P. Wolf ◽

D.M. Dorfman ◽

P. Fitzpatrick ◽

J.L. Baker ◽

...

Keyword(s):

Emergency Department ◽

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Emergency Department Patients ◽

D Dimer

Download Full-text

LO30: Prevalence of pulmonary embolism among emergency department patients with syncope: a multicenter prospective cohort study

CJEM ◽

10.1017/cem.2018.92 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S17-S17 ◽

Cited By ~ 1

Author(s):

V. Thiruganasambandamoorthy ◽

M. L.A. Sivilotti ◽

B. H. Rowe ◽

A. D. McRae ◽

M. Mukarram ◽

...

Keyword(s):

Emergency Department ◽

Pulmonary Embolism ◽

The United States ◽

Pulmonary Angiogram ◽

Emergency Department Patients ◽

Multicenter Prospective Cohort Study ◽

Multicenter Prospective Cohort ◽

D Dimer ◽

Combined Data

Introduction: The prevalence of pulmonary embolism (PE) among patients with syncope is understudied. Based on a recent study with an exceptionally high PE prevalence, some advocate investigating all syncope patients for PE, including those with another clear cause for their syncope. We sought to evaluate the PE prevalence among emergency department (ED) patients with syncope. Methods: We combined data from two large prospective studies enrolling adults with syncope from 17 EDs in Canada and the United States. Each study collected the results of investigations related to PE (i.e. D-dimer or ventilation-perfusion (VQ) scan, or computed tomography pulmonary angiogram (CTPA)), and 30-day adjudicated outcomes including diagnosis of PE, arrhythmia, myocardial infarction, serious hemorrhage and/or death. Results: Of the 9,091 patients (median age 66 years, 51.9% females, 39.1% hospitalized) with 30-day follow-up, 546 (6.0%) were investigated for PE: 278 (3.1%) had D-dimer, 39 (0.4%) had VQ and 347 (3.8%) patients had CTPA performed. 30-day outcomes included: 874 (9.6%) patients with any serious outcome; 0.9% deaths; and 818 (9.0%) patients with non-PE serious outcomes. Overall, 56 patients (prevalence 0.6%; 95% CI 0.5% 0.8%) were diagnosed with PE, including 8 (0.1%) of those admitted to hospital at the index presentation. Only 11 patients (0.1%) with a non-PE serious condition had a concomitant underlying PE identified. Conclusion: The prevalence of PE is very low among ED patients with syncope, including those hospitalized following syncope. While acknowledging syncope may be caused by an underlying PE, clinicians should be cautious against indiscriminate over-investigations for PE.

Download Full-text