EVALUATION OF THE ROLE OF D- DIMER TEST IN THE PREDICTION AND EXCLUSION OF VENOUS THROMBOEMBOLISM IN COMBINATION WITH PRETEST PROBABILITY SCORE AT A TERTIARY CARE CENTRE.

2021 ◽  
pp. 70-71
Author(s):  
Veerendra Tyagi ◽  
K.K Magnani ◽  
Jyoti P Shrivastava ◽  
Arun Jain ◽  
K.S. Mangal
Keyword(s):  
Venous Thromboembolism ◽  
Tertiary Care ◽  
Pretest Probability ◽  
Radiological Imaging ◽  
Imaging Studies ◽  
Tertiary Care Centre ◽  
Probability Score ◽  
Combined Use ◽  
D Dimer

Background: Clinical suspicion of venous thromboembolism requires objective testing to predict and exclude the diagnosis. Plasma D-dimer is sensitive marker for thrombosis but lack specicity. The combined use of pretest probability score and D-dimer can be used for exclusion of VTE and safely avoid costly imaging tests. Material and Methods: In this prospective observational study, we used Wells PTP score and D-dimer test to evaluate 50 patients who presented with sign and symptoms of VTE. Radiological imaging studies were taken as conrmatory test. Result: The sensitivity, specicity and NPV of D-dimer test were 100%, 83.7% and 100% respectively. The sensitivity, specicity and NPV of Ddimer test in combination with low PTP score were 100%, 72.1% and 100% respectively. The agreement between radiologically conrmed cases and D-dimer test was signicant. Conclusion: D-dimer test can be safely used in low or moderate PTP score patients to exclude VTE and costly invasive radiological imaging studies can be obviated in a signicant proportion of patients.

scholarly journals Combination pretest probability assessment and D-dimer did not reduce outpatient imaging for venous thromboembolism in a tertiary care hospital emergency department

CJEM ◽  
2014 ◽  
Vol 16 (01) ◽  
pp. 53-62 ◽  
Author(s):  
Sarah Ingber ◽  
Rita Selby ◽  
Jacques Lee ◽  
William Geerts ◽  
Elena Brnjac
Keyword(s):  
Emergency Department ◽  
Venous Thromboembolism ◽  
False Positive Rate ◽  
Tertiary Care ◽  
Real Life ◽  
Pretest Probability ◽  
Care Hospital ◽  
Ed Visits ◽  
The Impact ◽  
D Dimer

ABSTRACTIntroduction:Venous thromboembolism (VTE) is difficult to diagnose yet potentially life threatening. A low-risk pretest probability (PTP) assessment combined with a negative Ddimer can rule out VTE in two-thirds of outpatients, reducing the need for imaging. Real-life implementation of this strategy is associated with several challenges.Methods:We evaluated the impact of introducing a standardized diagnostic algorithm including a mandatory PTP assessment and D-dimer on radiologic test use for VTE in our emergency department (ED). A retrospective review of all ED visits for suspected VTE in the year prior to and following the introduction of this algorithm was conducted. VTE diagnosis was based on imaging. Guideline compliance was also assessed.Results:ED visits were investigated for suspected VTE in the pre- and postintervention periods (n 5 1,785). Most D-dimers (95%) ordered were associated with a PTP assessment, and 50% of visits assigned a low PTP had a negative D-dimer. The proportion of imaging tests ordered for VTE in all ED visits was unchanged postintervention (1.9% v. 2.0%). The proportion of patients with suspected VTE in whom VTE was confirmed on imaging decreased postintervention (10.2% v. 14.1%).Conclusion:In spite of excellent compliance with our algorithm, we were unable to reduce imaging for VTE. This may be due to a lower threshold for suspecting VTE and an increase in investigation for VTE combined with a high false positive rate of our D-dimer assay in low–pretest probability patients. This study highlights two common real-life challenges with adopting this strategy for VTE investigation.

scholarly journals Prevalence and characteristics of venous thromboembolism in severe exacerbation of chronic obstructive pulmonary disease in a tertiary care hospital in India

2021 ◽  
Author(s):  
Soibam Pahel Meitei ◽  
Sudheer Tale ◽  
Arjun Kumar Negi ◽  
Ruchi Dua ◽  
Rohit Walia ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Venous Thromboembolism ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Lower Limbs ◽  
Chronic Obstructive ◽  
Care Hospital ◽  
Obstructive Pulmonary Disease ◽  
Test Probability ◽  
D Dimer

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) carries a high risk of venous thromboembolism (VTE). Pulmonary embolism (PE) and AECOPD increase the mortality and morbidity risk associated with each other. Racial and ethnic differences in VTE risk have been documented in multiple studies. However, there is a dearth of reliable Indian data on the same. This study was planned to find the prevalence of VTE in the setting of severe AECOPD in a tertiary care hospital in India and to identify the clinical, laboratory and radiological characteristics of VTE in severe AECOPD. A total of 156 consecutive patients admitted with severe AECOPD and meeting the specified inclusion and exclusion criteria were recruited. Thorough workup of all patients was done including ABG, serum D dimer, ECG, compression ultrasound of lower limbs and 2-D echocardiography. Patients with high pre-test probability score, or intermediate pre-test probability score at presentation with serum D dimer above the age adjusted cut-off underwent computerised tomography pulmonary angiography (CTPA).  Results were analysed using SPSS version 23.  Sixteen (10.3%) patients had VTE, 15 (93.75%) of them being cases of isolated PE. Female gender, higher cumulative past exposure to corticosteroid, higher alveolar-arterial gradient, right ventricular dysfunction, and higher mean pulmonary artery pressure were associated with increased risk for VTE. The prevalence of VTE in AECOPD in this study among an Indian population is higher than among other Asians, but lower than among the Blacks, the Caucasians and the Middle-East ethnicities. Since a vast majority of VTE presents as PE without DVT in the setting of AECOPD, the absence of deep vein thrombosis of lower limbs does not rule PE in the setting.

scholarly journals Role of Colposcopy in Evaluation of Abnormal Cytology a Tertiary Care Centre Experience

2020 ◽  
Vol 10 (3) ◽  
pp. 130-134
Author(s):  
Sachan Rekha ◽  
Shukla Ayushi ◽  
Sachan Pushpalata ◽  
Patel ML ◽  
Shankhwar Pushpalata
Keyword(s):  
Tertiary Care ◽  
Care Centre ◽  
Abnormal Cytology ◽  
Tertiary Care Centre
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