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. 1998 Oct;53(10):830–834. doi: 10.1136/thx.53.10.830

Usefulness of D-dimer, blood gas, and respiratory rate measurements for excluding pulmonary embolism

P Egermayer 1, G Town 1, J Turner 1, D Heaton 1, A Mee 1, M Beard 1
PMCID: PMC1745091  PMID: 10193368

Abstract

BACKGROUND—A study was undertaken to assess the usefulness of the SimpliRED D-dimer test, arterial oxygen tension, and respiratory rate measurement for excluding pulmonary embolism (PE) and venous thromboembolism (VTE).
METHODS—Lung scans were performed in 517 consecutive medical inpatients with suspected acute PE over a one year period. Predetermined end points for objectively diagnosed PE in order of precedence were (1) a post mortem diagnosis, (2) a positive pulmonary angiogram, (3) a high probability ventilation perfusion lung scan when the pretest probability was also high, and (4) the unanimous opinion of an adjudication committee. Deep vein thrombosis (DVT) was diagnosed by standard ultrasound and venography.
RESULTS—A total of 40 cases of PE and 37 cases of DVT were objectively diagnosed. The predictive value of a negative SimpliRED test for excluding objectively diagnosed PE was 0.99 (error rate 2/249), that of PaO2 of ⩾80 mm Hg (10.7 kPa) was 0.97 (error rate 5/160), and that of a respiratory rate of ⩽20/min was 0.95 (error rate 14/308). The best combination of findings for excluding PE was a negative SimpliRED test and PaO2⩾80 mm Hg, which gave a predictive value of 1.0 (error rate 0/93). The predictive value of a negative SimpliRED test for excluding VTE was 0.98 (error rate 5/249).
CONCLUSIONS—All three of these observations are helpful in excluding PE. When any two parameters were normal, PE was very unlikely. In patients with a negative SimpliRED test and PaO2 of ⩾80 mm Hg a lung scan is usually unnecessary. Application of this approach for triage in the preliminary assessment of suspected PE could lead to a reduced rate of false positive diagnoses and considerable resource savings.



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Selected References

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  1. Bounameaux H., de Moerloose P., Perrier A., Miron M. J. D-dimer testing in suspected venous thromboembolism: an update. QJM. 1997 Jul;90(7):437–442. doi: 10.1093/qjmed/90.7.437. [DOI] [PubMed] [Google Scholar]
  2. Bounameaux H., de Moerloose P., Perrier A., Reber G. Plasma measurement of D-dimer as diagnostic aid in suspected venous thromboembolism: an overview. Thromb Haemost. 1994 Jan;71(1):1–6. [PubMed] [Google Scholar]
  3. Brenner B., Pery M., Lanir N., Jabareen A., Markel A., Kaftori J. K., Gaitini D., Rylatt D. Application of a bedside whole blood D-dimer assay in the diagnosis of deep vein thrombosis. Blood Coagul Fibrinolysis. 1995 May;6(3):219–222. doi: 10.1097/00001721-199505000-00004. [DOI] [PubMed] [Google Scholar]
  4. Douketis J. D., McGinnis J., Ginsberg J. S. The clinical utility of a rapid bedside D-dimer assay for screening of deep vein thrombosis following orthopaedic surgery. Thromb Haemost. 1997 Oct;78(4):1300–1301. [PubMed] [Google Scholar]
  5. Egermayer P. Perfusion scintigraphy in the diagnosis of pulmonary embolism. N Z Med J. 1980 Dec 24;92(674):462–464. [PubMed] [Google Scholar]
  6. Egermayer P., Town G. I., Ardagh M. Pleuritic pain and pulmonary embolism in the emergency department: diagnostic and treatment issues. N Z Med J. 1997 Jun 13;110(1045):197–199. [PubMed] [Google Scholar]
  7. Elias A., Aptel I., Huc B., Chalé J. J., Nguyen F., Cambus J. P., Boccalon H., Boneu B. D-dimer test and diagnosis of deep vein thrombosis: a comparative study of 7 assays. Thromb Haemost. 1996 Oct;76(4):518–522. [PubMed] [Google Scholar]
  8. Ginsberg J. S., Kearon C., Douketis J., Turpie A. G., Brill-Edwards P., Stevens P., Panju A., Patel A., Crowther M., Andrew M. The use of D-dimer testing and impedance plethysmographic examination in patients with clinical indications of deep vein thrombosis. Arch Intern Med. 1997 May 26;157(10):1077–1081. [PubMed] [Google Scholar]
  9. Goodman L. R., Lipchik R. J. Diagnosis of acute pulmonary embolism: time for a new approach. Radiology. 1996 Apr;199(1):25–27. doi: 10.1148/radiology.199.1.8633154. [DOI] [PubMed] [Google Scholar]
  10. Hull R. D., Hirsh J., Carter C. J., Raskob G. E., Gill G. J., Jay R. M., Leclerc J. R., David M., Coates G. Diagnostic value of ventilation-perfusion lung scanning in patients with suspected pulmonary embolism. Chest. 1985 Dec;88(6):819–828. doi: 10.1378/chest.88.6.819. [DOI] [PubMed] [Google Scholar]
  11. Hyers T. M. Diagnosis of pulmonary embolism. Thorax. 1995 Sep;50(9):930–932. doi: 10.1136/thx.50.9.930. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Kearon C., Hirsh J. The diagnosis of pulmonary embolism. Haemostasis. 1995 Jan-Apr;25(1-2):72–87. doi: 10.1159/000217145. [DOI] [PubMed] [Google Scholar]
  13. Lensing A. W., Doris C. I., McGrath F. P., Cogo A., Sabine M. J., Ginsberg J., Prandoni P., Turpie A. G., Hirsh J. A comparison of compression ultrasound with color Doppler ultrasound for the diagnosis of symptomless postoperative deep vein thrombosis. Arch Intern Med. 1997 Apr 14;157(7):765–768. [PubMed] [Google Scholar]
  14. Moser K. M., Guisan M., Bartimmo E. E., Longo A. M., Harsanyi P. G., Chiorazzi N. In vivo and post mortem dissolution rates of pulmonary emboli and venous thrombi in the dog. Circulation. 1973 Jul;48(1):170–178. doi: 10.1161/01.cir.48.1.170. [DOI] [PubMed] [Google Scholar]
  15. Perrier A., Bounameaux H., Morabia A., de Moerloose P., Slosman D., Didier D., Unger P-F, Junod A. Diagnosis of pulmonary embolism by a decision analysis-based strategy including clinical probability, D-dimer levels, and ultrasonography: a management study. Arch Intern Med. 1996 Mar 11;156(5):531–536. [PubMed] [Google Scholar]
  16. Santolicandro A., Prediletto R., Fornai E., Formichi B., Begliomini E., Giannella-Neto A., Giuntini C. Mechanisms of hypoxemia and hypocapnia in pulmonary embolism. Am J Respir Crit Care Med. 1995 Jul;152(1):336–347. doi: 10.1164/ajrccm.152.1.7599843. [DOI] [PubMed] [Google Scholar]
  17. Stein M., Levy S. E. Reflex and humoral responses to pulmonary embolism. Prog Cardiovasc Dis. 1974 Nov-Dec;17(3):167–174. doi: 10.1016/0033-0620(74)90041-3. [DOI] [PubMed] [Google Scholar]
  18. Stein P. D. Acute pulmonary embolism. Dis Mon. 1994 Sep;40(9):467–523. [PubMed] [Google Scholar]
  19. Stein P. D., Goldhaber S. Z., Henry J. W., Miller A. C. Arterial blood gas analysis in the assessment of suspected acute pulmonary embolism. Chest. 1996 Jan;109(1):78–81. doi: 10.1378/chest.109.1.78. [DOI] [PubMed] [Google Scholar]
  20. Szucs M. M., Jr, Brooks H. L., Grossman W., Banas J. S., Jr, Meister G., Dexter L., Dalen J. E. Diagnostic senstivity of laboratory findings in acute pulmonary embolism. Ann Intern Med. 1971 Feb;74(2):161–166. doi: 10.7326/0003-4819-74-2-161. [DOI] [PubMed] [Google Scholar]
  21. Turkstra F., Kuijer P. M., van Beek E. J., Brandjes D. P., ten Cate J. W., Büller H. R. Diagnostic utility of ultrasonography of leg veins in patients suspected of having pulmonary embolism. Ann Intern Med. 1997 May 15;126(10):775–781. doi: 10.7326/0003-4819-126-10-199705150-00005. [DOI] [PubMed] [Google Scholar]
  22. Turkstra F., van Beek E. J., ten Cate J. W., Büller H. R. Reliable rapid blood test for the exclusion of venous thromboembolism in symptomatic outpatients. Thromb Haemost. 1996 Jul;76(1):9–11. [PubMed] [Google Scholar]
  23. Veinot J. P., Ford S. E., Price R. G. Subacute cor pulmonale due to tumor embolization. Arch Pathol Lab Med. 1992 Feb;116(2):131–134. [PubMed] [Google Scholar]
  24. Wells P. S., Brill-Edwards P., Stevens P., Panju A., Patel A., Douketis J., Massicotte M. P., Hirsh J., Weitz J. I., Kearon C. A novel and rapid whole-blood assay for D-dimer in patients with clinically suspected deep vein thrombosis. Circulation. 1995 Apr 15;91(8):2184–2187. doi: 10.1161/01.cir.91.8.2184. [DOI] [PubMed] [Google Scholar]
  25. Worsley D. F., Alavi A. Comprehensive analysis of the results of the PIOPED Study. Prospective Investigation of Pulmonary Embolism Diagnosis Study. J Nucl Med. 1995 Dec;36(12):2380–2387. [PubMed] [Google Scholar]

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