D-Dimer in Venous Thromboembolism Diagnosis in The Emergency Department
DOI:
https://doi.org/10.24950/O/245/20/1/2021Keywords:
Emergency Service, Hospital, Fibrin and Fibrinogen Degradation Products, Venous ThromboembolismAbstract
Introduction: Venous thromboembolism (VTE) refers to deep vein thrombosis (DVT) and pulmonary embolism (PE). D-dimer dosing has sensitivity of over 95% and high negative predictive value for the diagnosis of VTE. Our goal was to analyse every Emergency Department episode in which d-dimer dosing was performed. The variables analysed were: presence or absence of clinical symptoms suggestive of VTE, the suitability of D-dimer request according to pre-test probability scores, performance of computed tomography angiography (angio-CT) if D-dimer elevation and number of confirmed VTE.
Methods: We performed a retrospectively analysis of all cases of patients over 18 years of age in whom D-Dimer dosing was performed in our Emergency Department from the 1st of July to the 31st of December of 2017.
Results: 589 episodes were included in our analysis. Female gender represented 61% (n = 361) and median age was 62 ± 19 years-old. We documented 110 episodes with D-dimer dosing without any suggestive symptoms of VTE. In four patients with high pre-test probability D-dimer was inadequately performed. D-dimer elevation was observed in 55,5% (327/589) of all episodes, but only 28,1% were submitted to angio-CT. Total VTE confirmed was 27 (4,6%).
Discussion and Conclusion: Our results are according to the literature. We report 3 main diagnostic errors: D-dimer dosing in patients without symptoms of VTE; D-dimer dosing in high probability patients; and patients with elevated D-dimer who do not do angio-CT. This study enlightens the prejudice of excessive and inadequate exams in the diagnosis of VTE.
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