JACC
HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
QUICK SEARCH:   [advanced]


     

J Am Coll Cardiol, 2002; 40:1475-1478
© 2002 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Dunn, K. L.
Right arrow Articles by Goldhaber, S. Z.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Dunn, K. L.
Right arrow Articles by Goldhaber, S. Z.

CLINICAL STUDY: PULMONARY EMBOLISM

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

Kelly L. Dunn, BA*, Jonathan P. Wolf, BS*, David M. Dorfman, MD, PhD{dagger}, Patricia Fitzpatrick, BS{dagger}, James L. Baker, MD, MPH{ddagger} and Samuel Z. Goldhaber, MD*,*

* Cardiovascular Division, Boston, Massachusetts, USA
{dagger} Department of Pathology and Hematology Laboratory, Boston, Massachusetts, USA
{ddagger} Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

Manuscript received April 25, 2002; revised manuscript received May 31, 2002, accepted June 7, 2002.

* Reprint requests and correspondence: Dr. Samuel Z. Goldhaber, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts, USA 02115.
sgoldhaber{at}partners.org

OBJECTIVES: We sought to determine: 1) whether normal D-dimer enzyme-linked immunosorbent assay (ELISA) assays predicted the absence of pulmonary embolism (PE) in the high-volume emergency department (ED) of the Brigham and Women’s Hospital, and 2) whether ED physicians accepted normal D-dimer levels as confirmation of no PE without further diagnostic testing such as lung scanning, chest computed tomography (CT) scanning, or pulmonary angiography.

BACKGROUND: Although the plasma D-dimer ELISA is a sensitive screening test for excluding acute PE, this laboratory marker has not been widely integrated into clinical algorithms such as creatine kinase-MB fraction or troponin testing for acute myocardial infarction.

METHODS: We mandated that ED physicians order D-dimer ELISA tests on all patients suspected of acute PE. We reviewed the clinical record of each ED patient initially evaluated for suspected PE during the year 2000. We determined whether additional imaging tests for PE were obtained and whether the final diagnosis was PE.

RESULTS: Of 1,106 D-dimer assays, 559 were elevated and 547 were normal. Only 2 of 547 had PE despite a normal D-dimer. The sensitivity of the D-dimer ELISA for acute PE was 96.4% (95% confidence interval [CI]: 87.5% to 99.6%), and the negative predictive value was 99.6% (95% CI: 98.7% to >99.9%). Nevertheless, 24% of patients with normal D-dimers had additional imaging tests for PE.

CONCLUSIONS: The D-dimer ELISA has a high negative predictive value for excluding PE. By paying more attention to normal D-dimer results, fewer chest CT scans and lung scans will be required, and improvements may be realized in diagnostic efficiency and cost reduction.

Abbreviations and Acronyms
  ED
  emergency department
  ELISA
  enzyme-linked immunosorbent assay
  CI
  confidence interval
  CT
  computed tomography
  PE
  pulmonary embolism




This article has been cited by other articles:


Home page
 CirculationHome page
G. Piazza and S. Z. Goldhaber
Acute Pulmonary Embolism: Part I: Epidemiology and Diagnosis
Circulation, July 11, 2006; 114(2): e28 - e32.
[Full Text] [PDF]

Home page
 Am. J. Roentgenol.Home page
M. S. Parker, F. K. Hui, M. A. Camacho, J. K. Chung, D. W. Broga, and N. N. Sethi
Female Breast Radiation Exposure During CT Pulmonary Angiography
Am. J. Roentgenol., November 1, 2005; 185(5): 1228 - 1233.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
C. Kabrhel, C. A. Camargo Jr, and S. Z. Goldhaber
Clinical Gestalt and the Diagnosis of Pulmonary Embolism: Does Experience Matter?
Chest, May 1, 2005; 127(5): 1627 - 1630.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
P. Rosenberger, S. K. Shernan, S. C. Body, and H. K. Eltzschig
Utility of Intraoperative Transesophageal Echocardiography for Diagnosis of Pulmonary Embolism
Anesth. Analg., July 1, 2004; 99(1): 12 - 16.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
U. J. Schoepf, S. Z. Goldhaber, and P. Costello
Spiral Computed Tomography for Acute Pulmonary Embolism
Circulation, May 11, 2004; 109(18): 2160 - 2167.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
J. A. Caprini, C. J. Glase, C. B. Anderson, and K. Hathaway
Laboratory Markers in the Diagnosis of Venous Thromboembolism
Circulation, March 30, 2004; 109(12_suppl_1): I-4 - I-8.
[Abstract] [Full Text]

Home page
 RadiologyHome page
U. J. Schoepf and P. Costello
CT Angiography for Diagnosis of Pulmonary Embolism: State of the Art
Radiology, February 1, 2004; 230(2): 329 - 337.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
S. Z. Goldhaber and C. G. Elliott
Acute Pulmonary Embolism: Part I: Epidemiology, Pathophysiology, and Diagnosis
Circulation, December 2, 2003; 108(22): 2726 - 2729.
[Full Text] [PDF]

Home page
 Clin. Chem.Home page
M. D. Brown, J. Lau, R. D. Nelson, and J. A. Kline
Turbidimetric D-Dimer Test in the Diagnosis of Pulmonary Embolism: A Metaanalysis
Clin. Chem., November 1, 2003; 49(11): 1846 - 1853.
[Abstract] [Full Text] [PDF]


HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
Copyright © 2002 by the American College of Cardiology Foundation.