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Computed tomographic pulmonary angiography and pulmonary embolism: predictive value of a d-dimer assay
BACKGROUND: Computed tomographic pulmonary angiography (CTPA) is increasingly being used as first investigation for suspected pulmonary embolism (PE). The investigation has high predictive value, but is resource and time intensive and exposes patients to considerable radiation. Our aim was to assess...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3305359/ https://www.ncbi.nlm.nih.gov/pubmed/22340133 http://dx.doi.org/10.1186/1756-0500-5-104 |
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author | Deonarine, Patricia de Wet, Carl McGhee, Alistair |
author_facet | Deonarine, Patricia de Wet, Carl McGhee, Alistair |
author_sort | Deonarine, Patricia |
collection | PubMed |
description | BACKGROUND: Computed tomographic pulmonary angiography (CTPA) is increasingly being used as first investigation for suspected pulmonary embolism (PE). The investigation has high predictive value, but is resource and time intensive and exposes patients to considerable radiation. Our aim was to assess the potential value of a negative d-dimer assay to exclude pulmonary emboli and reduce the number of performed CTPAs. METHODS: All CTPAs performed in a Scottish secondary care hospital for a fourteen month period were retrospectively reviewed. Collected data included the presence or absence of PE, d-dimer results and patient demographics. PE positive CTPAs were reviewed by a specialist panel. RESULTS: Pulmonary embolisms were reported for 66/405 (16.3%) CTPAs and d-dimer tests were performed for 216 (53%). 186/216 (86%) patients had a positive and 30 (14%) a negative d-dimer result. The panel agreed 5/66 (7.6%) false positive examinations. The d-dimer assay's negative predictive value was 93.3% (95% CI = 76.5%-98.8%) based on the original number of positive CTPAs and 100% (95% CI = 85.9%-100%) based on expert review. Significant non-PE intrapulmonary pathology was reported for 312/405 (77.0) CTPAs, including 13 new diagnoses of carcinoma. CONCLUSIONS: We found that a low d-dimer score excluded all pulmonary embolisms, after a further specialist panel review identified initial false positive reports. However, current evidence-based guidelines still recommend that clinicians combine a d-dimer result with a validated clinical risk score when selecting suitable patients for CTPA. This may result in better use of limited resources, prevent patients being exposed to unnecessary irradiation and prevent potential complications as a result of iodinated contrast. |
format | Online Article Text |
id | pubmed-3305359 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-33053592012-03-16 Computed tomographic pulmonary angiography and pulmonary embolism: predictive value of a d-dimer assay Deonarine, Patricia de Wet, Carl McGhee, Alistair BMC Res Notes Research Article BACKGROUND: Computed tomographic pulmonary angiography (CTPA) is increasingly being used as first investigation for suspected pulmonary embolism (PE). The investigation has high predictive value, but is resource and time intensive and exposes patients to considerable radiation. Our aim was to assess the potential value of a negative d-dimer assay to exclude pulmonary emboli and reduce the number of performed CTPAs. METHODS: All CTPAs performed in a Scottish secondary care hospital for a fourteen month period were retrospectively reviewed. Collected data included the presence or absence of PE, d-dimer results and patient demographics. PE positive CTPAs were reviewed by a specialist panel. RESULTS: Pulmonary embolisms were reported for 66/405 (16.3%) CTPAs and d-dimer tests were performed for 216 (53%). 186/216 (86%) patients had a positive and 30 (14%) a negative d-dimer result. The panel agreed 5/66 (7.6%) false positive examinations. The d-dimer assay's negative predictive value was 93.3% (95% CI = 76.5%-98.8%) based on the original number of positive CTPAs and 100% (95% CI = 85.9%-100%) based on expert review. Significant non-PE intrapulmonary pathology was reported for 312/405 (77.0) CTPAs, including 13 new diagnoses of carcinoma. CONCLUSIONS: We found that a low d-dimer score excluded all pulmonary embolisms, after a further specialist panel review identified initial false positive reports. However, current evidence-based guidelines still recommend that clinicians combine a d-dimer result with a validated clinical risk score when selecting suitable patients for CTPA. This may result in better use of limited resources, prevent patients being exposed to unnecessary irradiation and prevent potential complications as a result of iodinated contrast. BioMed Central 2012-02-17 /pmc/articles/PMC3305359/ /pubmed/22340133 http://dx.doi.org/10.1186/1756-0500-5-104 Text en Copyright ©2012 Deonarine et al; BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Deonarine, Patricia de Wet, Carl McGhee, Alistair Computed tomographic pulmonary angiography and pulmonary embolism: predictive value of a d-dimer assay |
title | Computed tomographic pulmonary angiography and pulmonary embolism: predictive value of a d-dimer assay |
title_full | Computed tomographic pulmonary angiography and pulmonary embolism: predictive value of a d-dimer assay |
title_fullStr | Computed tomographic pulmonary angiography and pulmonary embolism: predictive value of a d-dimer assay |
title_full_unstemmed | Computed tomographic pulmonary angiography and pulmonary embolism: predictive value of a d-dimer assay |
title_short | Computed tomographic pulmonary angiography and pulmonary embolism: predictive value of a d-dimer assay |
title_sort | computed tomographic pulmonary angiography and pulmonary embolism: predictive value of a d-dimer assay |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3305359/ https://www.ncbi.nlm.nih.gov/pubmed/22340133 http://dx.doi.org/10.1186/1756-0500-5-104 |
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