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Monique G.L. Leclercq, Johan G. Lutisan, Marinus van Marwijk Kooy, Bart F. Kuipers, Ad H.J. Oostdijk, Jef J.C.M. van der Leur, Harry R. Bller
Ruling out clinically suspected pulmonary embolism by assessment of clinical probability and D-dimer levels: a management study
D-dimer test combined with clinical probability assessment has been proposed as the first step in the diagnostic work-up of patients with suspected pulmonary embolism (PE). In a prospective management study we investigated the safety and efficiency of excluding PE by a normal D-dimer combined with a low or moderate clinical probability. Of the 202 study patients this combination ruled out PE in 64 (32%) patients. The 3-month thromboembolic risk in these patients was 0% (95% CI, 0.0-5.6%). The prevalence of PE in the entire cohort was 29% (59 patients), whereas in the low, moderate and high clinical probability groups this was 25%, 26% and 50%, respectively. We conclude that ruling out suspected PE by a normal D-dimer combined with a low or moderate clinical probability appears to be a safe and efficient strategy. The accuracy of the clinical probability assessment is modest.
Thrombosis and Haemostasis, Schattauer
Print ISSN: 0340-6245
Volume: 89, 01/2003
Pages: 97 - 103