D-dimer: A role in ruling out pulmonary embolism in an emergency care department

Renata Hadžić,Žana Maksimović,Mladen Stajić,Dragana Lončar-Stojiljković

doi:10.5937/scriptamed51-25479

Abstract

Background/Aim: Pulmonary embolism (PE) is a diagnostic challenge, particularly in prehospital care. The aim of this study was to determine to what extent the evaluation of D-dimer value helps physicians with differentiation of PE and whether D-dimer values are in correlation with the values of revised Geneva score. Methods: Data have been collected for the patients whose D-dimer has been evaluated at the Emergency Care Department of the City of Banja Luka in 2018. Gender, age, symptoms, working diagnosis and D-dimer value have all been recorded and also the fact whether the patient was referred to hospital treatment or not. For each patient the revised Geneva score was determined. Results: Sixty-eight tests were done in 2018. Out of 68 tests, 41 were negative (60.3 %). D-dimer results helped in making decisions about referring patients to the hospital or not (ch2 = 36.32, p < 0.001). Patients with elevated D-dimer levels, especially where the values were four times higher than the reference ones typically were referred to hospital treatment, whereas 67.5% patients with negative D-dimer results were sent home after giving a treatment and advice. In the elderly patients D-dimer was statistically more positive (F = 10.82, p < 0.001). Values of D-dimer were not significantly different regarding gender (ch2 = 2.19, p = 0.33). According to the results of the revised Geneva score, 5.1 % of patients had high risk of PTE, while moderate and low risk had 47.5 % each. Although it has been found that the values of D-dimer were slightly more elevated at higher values of the revised Geneva score and that the difference was not statistically significant (ch2 = 7.71, p = 0.10). Conclusion: Values of D-dimer considerably helped in differentiation of PE in the Emergency Care Department. D-dimer has a high negative predictive value and should be used to exclude PE diagnosis for patients with low clinical probability of PE.

Highlights

Pulmonary embolism (PE) is one of the most difficult conditions to diagnose, in the prehospital care
The aim of this study was to determine to what extent the evaluation of D-dimer value helps physicians with differentiation of PE and whether D-dimer values are in correlation with the values of revised Geneva score
Data have been collected for the patients whose D-dimer has been evaluated at the Emergency Care Department of the City of Banja Luka in 2018

Summary

Introduction

Pulmonary embolism (PE) is one of the most difficult conditions to diagnose, in the prehospital care. It represents the most serious clinical manifestation of venous thromboembolism (VTE), which represents the third most common cardiovascular disease.[1,2,3,4] The main cause of PE-related deaths is the undiagnosed PE during lifetime (59 %), followed by sudden fatal PE (34 %). It is estimated that only 7 % of patients who died from PE had PE diagnosed on time.[5,6,7] Frequency of PE is hard to determine because it can sometimes remain asymptomatic and go unsuspected, while on the other hand PE is often accidentally diagnosed as an incidental finding.[8]. This article should be cited as follows: Hadžić R, Maksimović ŽM, Stajić M, Lončar-Stojiljković D. Scr Med 2020;51(1):[28,29,30,31,32,33]

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