In:
British Journal of Haematology, Wiley, Vol. 92, No. 3 ( 1996-02), p. 725-732
Abstract:
Objective . To determine the role of four ELISA D‐dimer assays in the exclusion of pulmonary embolism. Design . Blinded comparison using pulmonary angiography and/or lung scintigraphy as a reference method. Setting . A secondary and tertiary referral centre. Patients and methods . Consecutive patients with suspected pulmonary embolism underwent lung scintigraphy, followed by angiography if a non‐diagnostic result was obtained. Comorbid conditions resulting in elevated plasma D‐dimer levels were defined a priori . Cut‐off levels for 100% sensitivity were determined. A decision‐analytic model was used to determine effectiveness and costs in the management pulmonary embolism. Main outcome measures . The exclusion efficacy of the various assays at a sensitivity of 100%, and cost‐effectiveness. Results . A total of 179 patients were included (78 inpatients and 101 outpatients; 74 patients had comorbid conditions). Pulmonary embolism could be adequately excluded in between 8% and 18% of all patients, and in between 3% and 7% and 11% and 27% of inpatients and outpatients, respectively, depending on the assay used. D‐dimer assays could exclude pulmonary embolism in 〈 5% of patients with comorbid conditions, whereas this increased to 14–32% in outpatients without comorbid conditions. A cost‐effectiveness analysis showed a cost reduction of 10% at a specificity of 30%, largely due to a 28% decrease in angiography requirements. Furthermore, for every 2% decrease in sensitivity, one per 1000 evaluated patients would die as a result of inadequately treated pulmonary embolism. Conclusion . D‐dimer ELISA assays may have a role in the exclusion of pulmonary embolism in symptomatic outpatients, where the application may reduce angiography by 30% and costs by 10%.
Type of Medium:
Online Resource
ISSN:
0007-1048
,
1365-2141
DOI:
10.1046/j.1365-2141.1996.375911.x
Language:
English
Publisher:
Wiley
Publication Date:
1996
detail.hit.zdb_id:
1475751-5
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