Ruling out clinically suspected pulmonary embolism by assessment of clinical probability and D-dimer levels: a management study |
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Authors: | Leclercq Monique G L Lutisan Johan G van Marwijk Kooy Marinus Kuipers Bart F Oostdijk Ad H J van der Leur Jef J C M Büller Harry R |
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Affiliation: | Department of Internal Medicine, Isala clinics, location Sophia, Zwolle, The Netherlands. jl@jager-leclercq.demon.nl |
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Abstract: | D-dimer test combined with clinical probability assessment has been proposed as the first step in the diagnostic work-up of patients with suspected pulmonary embolism (PE). In a prospective management study we investigated the safety and efficiency of excluding PE by a normal D-dimer combined with a low or moderate clinical probability. Of the 202 study patients this combination ruled out PE in 64 (32%) patients. The 3-month thromboembolic risk in these patients was 0% (95% CI, 0.0-5.6%). The prevalence of PE in the entire cohort was 29% (59 patients), whereas in the low, moderate and high clinical probability groups this was 25%, 26% and 50%, respectively. We conclude that ruling out suspected PE by a normal D-dimer combined with a low or moderate clinical probability appears to be a safe and efficient strategy. The accuracy of the clinical probability assessment is modest. |
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