Key result
Elevated D-dimer levels were not significantly associated with a positive diagnosis of pulmonary embolism on CTPA compared to negative D-dimer levels (14% vs 20%; p=0.175).
Why the study?
Pulmonary embolism causes severe complications and requires timely diagnosis, prompting evaluation of the relationship between elevated D-dimer levels and positive CTPA findings in patients with suspected disease.
Does an elevated D-dimer level predict a positive CTPA for pulmonary embolism in patients with chest pain and suspected PE?
Observational (n=1,219)
No
Does an elevated D-dimer level predict a positive CTPA for pulmonary embolism in patients with chest pain and suspected PE?
Absolute Event Rate: 14% vs 20%
p-value: p=0.175
There is no strong relationship between elevated D-dimer levels and positive CTPA for PE in this setting, suggesting a need to refine clinical decision rules to limit unnecessary CTPA referrals.
May support CTPA use in suspected PE; leaves open prospective validation before changing algorithms.
Background: Pulmonary embolism (PE), a common heart and blood vessel disease, causes complications such as haemodynamic instability and cardiovascular mortality. Timely diagnosis and treatment are imperative for managing this potentially life-threatening condition. Aim: The aim of this study was to establish the relationship between an elevated D-dimer level and a positive computed tomography pulmonary angiogram (CTPA), which could confirm PE in patients with chest pain and suspected PE. Setting: Data were collected at a private diagnostic radiology practice located in Bloemfontein, South Africa. Methods: Data were retrospectively collected from the Picture Archiving and Communications System (PACS). Results: Of the sampled patients (n = 1219), only 16.7% were diagnosed with PE after CTPA. Approximately 14% of the D-dimer-positive patient group were diagnosed with PE and, in the D-dimer-negative patient group, approximately 20% of the patients were diagnosed with PE. Of the patients sampled, 86% were not diagnosed with PE despite having increased D-dimer values. No specific trends in the relation between elevated D-dimer levels and a positive PE diagnosis could be identified at the significance level of 0.05; a Chi-square test of independence indicated (χ2 [1, N = 995] = 1.84, p = 0.175). Conclusion: No strong relationship between elevated D-dimer levels in the blood and a positive yield of PE after CTPA; was found hence, clinical decision rules for PE workups need refining, especially to limit unnecessary CTPA referrals in this setting. Contribution: The findings suggest that PE workup at the private practice should be revised to improve the quality of service.
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Kruger et al. (2024) conducted an observational in Suspected pulmonary embolism (n=1,219). Elevated D-dimer levels vs. Negative D-dimer levels was evaluated on Positive computed tomography pulmonary angiogram (CTPA) confirming pulmonary embolism (p=0.175). Elevated D-dimer levels were not significantly associated with a positive diagnosis of pulmonary embolism on CTPA compared to negative D-dimer levels (14% vs 20%; p=0.175).
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