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 COMPARISON OF 128-SLICE SPIRAL COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAPHY (CTPA) FINDINGS WITH PLASMA D-DIMER LEVELS IN PATIENTS WITH CLINICAL SUSPICION OF PULMONARY EMBOLISM

2021 ◽  
Vol 71 (6) ◽  
pp. 1962-66
Author(s):  
Uzma Nisar ◽  
Hina Nasir ◽  
Atiq Ur Rehman Slehria ◽  
Abdur Rahim Rahim Palwa ◽  
Rashid Hussain ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Armed Forces ◽  
Pulmonary Angiography ◽  
Clinical Suspicion ◽  
Spiral Computed Tomography ◽  
Military Hospital ◽  
Spiral Computed ◽  
Computed Tomography Pulmonary Angiography ◽  
D Dimer

Objective: To compare the effectiveness of plasma D-dimer levels with findings of 128-slice spiral computed tomography pulmonary angiography (CTPA) in patients with clinical suspicion of pulmonary embolism. Study Design: Retrospective observational study Place and Duration of Study: Department of Computed Tomography, Armed Forces Institute of Radiology & Imaging, Pak Emirates Military Hospital Rawalpindi, from Jan 2018 to Dec 2018. Methodology: A total of 59 patients were inducted who presented in Emergency Department, Pak Emirates Military Hospital Rawalpindi with clinical suspicion of Pulmonary Embolism. The main symptoms were shortness of breath and chest pain. Plasma D-dimer levels of all patients were sent to laboratory and CTPA was performed at Computed Tomography department, Armed Forces Institute of Radiology & Imaging using 128-slice spiral computed tomography. Results: 36 patients (61%) were males and 23 (39%) were females with an average age of 48.03 ± 18.06 years (range 23-85 years). Out of 59 patients, D-dimer levels were raised in 28 cases (47.4%) while 31 patients (52.6%) showed normal levels. Pulmonary Embolism was detected by CTPA in 30 cases (50.8%) while 29 patients (49.2%) were without obvious abnormality. Conclusion: Plasma D-Dimer levels show low sensitivity, specificity and negative predictive value and cannot exclude Pulmonary Embolism without CTPA. Computed Tomography Pulmonary Angiography (CTPA) remains diagnostic modality of choice for definitive assessment of Pulmonary Embolism in patients reporting at the emergency reception.

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.

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.

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