PT  - JOURNAL ARTICLE
AU  - Diana Lees
AU  - Paul Griffiths
AU  - Carol Paxton
AU  - Zaroug Wahbi
TI  - Can D-dimer assay, together with clinical probability predict computed tomography pulmonary angiogram (CTPA) outcomes for pulmonary embolism (PE)?
DP  - 2011 Sep 01
TA  - European Respiratory Journal
PG  - p582
VI  - 38
IP  - Suppl 55
4099  - http://erj.ersjournals.com/content/38/Suppl_55/p582.short
4100  - http://erj.ersjournals.com/content/38/Suppl_55/p582.full
SO  - Eur Respir J2011 Sep 01; 38
AB  - Introduction: Annual incidence of PE is estimated at 60-70/100 000. Current National Guidelines recommend patients presenting with suspected PE should be risk-assessed according to presenting symptoms, risk factors, clinical findings, and investigation results. Fear of missing potentially life-threatening PE likely results in over-investigation.Aims: To assess if we are identifying patients correctly based upon pre-imaging risk scores and whether there is a D-dimer level most consistent with the diagnosis.Method: A retrospective review of patients attending for CTPA in a one month period. Clinical indicators were documented and patients were divided into risk groups.Results: 38 patients had a CTPA. 20 (52%) male. Age range 20-99years (median 62). 6 (15%) did not have a D-dimer. 22 (58%) had a major risk factor for PE, and 16 had a minor risk factor. 32 (84%) patients had a positive D-dimer (>200 ng/mL).In the high risk group 8/22 had a positive CTPA with median D-dimer of 1552ng/mL. 14/22 were negative for PE with median D-dimer of 345ng/mL. The remaining 16 patients who were low risk were all negative for PE on CTPA, median D-dimer 570ng/mL.Conclusion: The results show that improvements can be made in investigating patients with suspected PE. A D-dimer level higher than that classed as positive in our hospital trust may be more appropriate from this small sample size. Further review with a larger number of patients is required.This may reduce the financial costs but more importantly will provide patients with appropriate directed care and reduced risk from radiological exposure.