Studies Validate Use of D-Dimer
Two new research studies may encourage broader utilization of the D-dimer test to evaluate patients with indicators suggestive of pulmonary embolism (PE). More recently, the gold standard to assess patients for PE has become multislice CT angiography (CTA). The two studies published, however, indicate that a D-dimer blood test is an effective method to rule out PE, as described by Diagnostic Imaging. These studies were presented at the American Roengten Ray Society Meeting.
As such, D-dimer is generally reserved as a test to assess level of risk and support clinical decision-making. The replacement of the D-dimer with other tests resulted from concerns about test sensitivity among groups at high risk of developing PE. D-dimer, however, may gain favor because of concerns about using CT and the radiation exposure associated with such.
A study completed by researchers at the Rosalind Franklin University University of Medicine and Science in Chicago assessed more than 500 patients suspected of having PE, based on clinical evidence. Patients were recruited from the emergency department setting over an eight month period. Screening for PE was completed with three different tests: quantitative D-dimer, pulmonary CTA, and revised Geneva score.
Study findings support use of D-dimer for patients with low and intermediate clinical risk. Additionally, if D-dimer was used as a first-line assessment tool, approximately 25 percent of CTAs could be avoided.
A study was completed collaboratively by researchers in Hawaii from the John A. Burns School of Medicine and the Honolulu Kaiser Foundation Hospital. This research group examined the D-dimer test in a cohort of 347 patients. Similarly, the cohort was comprised of patients who presented to the ER with evidence of PE. Patients underwent scanning with CTA and the D-dimer test.
Patients were assessed according to the Wells clinical prediction score, which evaluates the clinical probability of PE. All participants had a D-dimer less than 1 microgram/mL. Findings indicate that patients with a low D-dimer score based on serum testing may not benefit from the Wells clinical assessment criteria.
April 24, 2008 Related topics: Laboratory, Monitoring, Imaging, Diagnostic