Risk assessment for pulmonary embolism (PE) currently relies on physician judgment, clinical decision rules (CDR), and D-dimer testing. There is still controversy regarding the role of D-dimer testing in low or intermediate risk patients. The objective of the study was to define the role of clinical decision rules and D-dimer testing in patients suspected of having a PE. Records of 894 patients referred for computed tomography pulmonary angiography (CTPA) at a University medical center were analyzed. The clinical decision rules overall had an ROC of approximately 0.70, while signs of DVT had the highest ROC (0.80). A low probability CDR coupled with a negative age-adjusted D-dimer largely excluded PE. The negative predictive value (NPV) of an intermediate CDR was 86-89%, while the addition of a negative D-dimer resulted in NPVs of 94%. Thus, in patients suspected of having a PE, a low or intermediate CDR does not exclude PE; however, in patients with an intermediate CDR, a normal age-adjusted D-dimer increases the NPV.
Bibliographical noteFunding Information:
The authors acknowledge the statistical help of Blythe Durbin-Johnson, Ph.D., in the Department of Public Health Sciences. The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant no. UL1 TR001860. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. This material is also the result of work supported with resources and facilities of the VA Northern California Health Care System.
© 2017 Jacob Ortiz et al.