Purpose The diagnosis of pulmonary embolism (PE) remains elusive due to the non-specific presentation of patients with the disease. The D-dimer blood test has been proven effective in ruling-out PE in patients stratified into a low-risk category, yet no study has confirmed its effectiveness in those with a moderate or high pre-test probability (PTP). This study attempts to determine the clinical outcomes of patients categorized as moderate to high risk for PE who had negative D-dimer test results (≤500 ng/mL.)
Methods A prospective study was performed based on the current University of Colorado Hospital protocol for patients suspected of PE between 1/24/03 and 8/4/04. Patients were enrolled when a D-dimer test was ordered for suspected PE and a research assistant was available. Two physicians (attending and senior resident) ranked PTP on a validated point scale and on their clinical gestalt. Subsequent tests were reviewed and ≥3-month follow-up was performed on all patients with moderate or high PTP and negative D-dimer results.
Results Among the 259 patients enrolled in the study between 1/24/03 and 8/4/04, 44 had a non-low PTP according to Wells assessment by the attending physician. Seventeen of these patients had radiological imaging studies during their visit (15 CTPE, 2 V/Q). All of these studies were negative for acute PE. Twenty-four patients (73%), out of a possible 33 for whom a 3-month window had elapsed, were available for follow-up. None of these patients were diagnosed with PE in the interim.
Conclusions The results suggest that a negative D-dimer result safely rules out acute PE in non-low PTP patients.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.