Key result
Variable guideline alignment in rural D-dimer ordering potentially limits clinical usefulness.
D-dimer ordering patterns at a rural Australian hospital often deviate from guidelines, highlighting a need for better documentation of pre-test probability and targeted education.
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Interpret D-dimer results cautiously without documented pre-test probability in rural EDs; leaves open impact of targeted education on guideline adherence.
OBJECTIVE: To explore patterns of D-dimer assay ordering for the diagnosis of pulmonary embolism (PE) and evaluate its clinical usefulness at Dubbo Health Service. METHODS: Retrospective audit of patients presenting to Dubbo Health Service between 1 January and 31 December 2024 who underwent D-dimer testing. D-dimer and CTPA ordering patterns were categorised according to their alignment with the guideline-recommended investigation sequence, which informed interpretation of test utilisation in the clinical context. RESULTS: A total of 245 D-dimer results were included (119 positive, 126 negative). In 79.2% of cases, investigation sequences followed the guideline-recommended order of testing. The diagnostic yield of CTPA among patients who underwent D-dimer testing was 4.9%. DISCUSSION: Ordering patterns were broadly consistent with published reports of increasing utilisation of D-dimer testing and CTPA. Discordant pathways most commonly involved positive D-dimer results without subsequent CTPA, or CTPA performed despite a negative D-dimer. CONCLUSION: Patterns of D-dimer ordering were variably aligned with guideline-recommended pathways, which may limit the clinical usefulness of the test in some cases. Improved documentation of pre-test probability and targeted education regarding appropriate test selection and interpretation may enhance the integration of D-dimer testing into diagnostic workflows.
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Hill et al. (2026) studied this question. D-dimer assay ordering patterns at an Australian rural hospital were variably aligned with guideline-recommended pathways, potentially limiting the test's clinical usefulness.
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