What question did this study set out to answer?

To evaluate the sensitivity, specificity, and practical clinical utility of various D-dimer assays for excluding deep vein thrombosis and pulmonary embolism in emergency care settings.

October 1, 2003Emergency Medicine News

The Clinical Utility of D-dimer Testing in Diagnosing Venous Thromboembolic Disease

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Why the study?

Does D-dimer testing accurately diagnose or exclude venous thromboembolism in patients with suspected disease?

Population

Patients with suspected venous thromboembolism, frequently presenting to the emergency department or…

Comparison

D-dimer testing. vs Gold standard diagnostic imaging or clinical…

Design

Review

Authors

DMDan S. MoselyJoint Base San Antonio RKRobert F. KacprowiczBrooke Army Medical Center

Discussion

Member takes

Implication

Supports D-dimer rule-out in low-probability VTE; leaves open assay performance across broader populations.

Key Points

To evaluate the sensitivity, specificity, and practical clinical utility of various D-dimer assays for excluding deep vein thrombosis and pulmonary embolism in emergency care settings.
Reviewed diagnostic performance studies evaluating enzyme-linked immunosorbent assays (ELISA), rapid ELISA, and agglutination tests compared against imaging gold standards including venography and pulmonary angiography.
Assessed outcomes across clinical trial cohorts, clinical decision algorithms, and a meta-analysis of prospective outpatient investigations.
Standard and rapid quantitative ELISA assays achieved high sensitivities up to 100%, with a meta-analysis demonstrating a pooled sensitivity of 0.94 (95% CI 0.88–0.97) and specificity of 0.45 (95% CI 0.36–0.55) for pulmonary embolism.
Qualitative latex and whole-blood agglutination assays showed lower and inconsistent sensitivities (80% to 94%), making them insufficient as standalone rule-out modalities.
In a cohort of 703 low pretest probability patients, a negative D-dimer yielded a likelihood ratio of 0.27 and reduced posterior probability of pulmonary embolism to 1.0%.

Structured PICO

Does D-dimer testing accurately diagnose or exclude venous thromboembolism in patients with suspected disease?

Population

Patients with suspected venous thromboembolism (distal venous thrombosis or pulmonary embolus), frequently presenting to the emergency department or outpatient settings.

Intervention

D-dimer testing (including standard ELISA, rapid quantitative ELISA such as VIDAS and STA-Liatest, and qualitative agglutination assays).

Comparator

Gold standard diagnostic imaging (e.g., contrast venography, pulmonary angiography) or clinical evaluation.

Outcome

Diagnostic accuracy (sensitivity, specificity, and negative predictive value) for the presence or absence of venous thromboembolism.

Highly sensitive D-dimer assays are clinically useful for excluding venous thromboembolism, but their low specificity requires them to be used selectively in appropriate patient populations with low pre-test probability.

Limitations

Heterogeneity of populations across studies
Prevalence of disease, duration of illness, and comorbid diseases confound negative predictive value data
Lack of consistent gold standard testing (e.g., angiography) in some of the reviewed studies
Universally low specificity of D-dimer assays due to elevation in numerous other conditions

Cite This Study

Mosely et al. (2003) studied this question.

synapsesocial.com/papers/6a7140a735aa2c282ce29081 https://doi.org/10.1097/00132981-200310000-00038

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The Clinical Utility of D-dimer Testing in Diagnosing Venous Thromboembolic Disease

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

The Clinical Utility of D-dimer Testing in Diagnosing Venous Thromboembolic Disease

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

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