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BMC Emergency Medicine
Published in: BMC Emergency Medicine 1/2021

Open Access 01-12-2021 | Computed Tomography | Research article

Utilization of serum D-dimer assays prior to computed tomography pulmonary angiography scans in the diagnosis of pulmonary embolism among emergency department physicians: a retrospective observational study

Authors: Leila Salehi, Prashant Phalpher, Hubert Yu, Jeffrey Jaskolka, Marc Ossip, Christopher Meaney, Rahim Valani, Mathew Mercuri

Published in: BMC Emergency Medicine | Issue 1/2021

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Abstract

Background

A variety of evidence-based algorithms and decision rules using D-Dimer testing have been proposed as instruments to allow physicians to safely rule out a pulmonary embolism (PE) in low-risk patients.

Objective

To describe the prevalence of D-Dimer utilization among emergency department (ED) physicians and its impact on positive yields and utilization rates of Computed Tomography Pulmonary Angiography (CTPA).

Methods

Data was collected on all CTPA studies ordered by ED physicians at three sites during a 2-year period. Using a chi-square test, we compared the diagnostic yield for those patients who had a D-Dimer prior to their CTPA and those who did not. Secondary analysis was done to examine the impact of D-Dimer testing prior to CTPA on individual physician diagnostic yield or utilization rate.

Results

A total of 2811 CTPAs were included in the analysis. Of these, 964 CTPAs (34.3%) were ordered without a D-Dimer, and 343 (18.7%) underwent a CTPA despite a negative D-Dimer. Those CTPAs preceded by a D-Dimer showed no significant difference in positive yields when compared to those ordered without a D-Dimer (9.9% versus 11.3%, p = 0.26). At the individual physician level, no statistically significant relationship was found between D-Dimer utilization and CTPA utilization rate or diagnostic yield.

Conclusion

This study provides evidence of suboptimal adherence to guidelines in terms of D-Dimer screening prior to CTPA, and forgoing CTPAs in patients with negative D-Dimers. However, the lack of a positive impact of D-Dimer testing on either CTPA diagnostic yield or utilization rate is indicative of issues relating to the high false-positive rates associated with D-Dimer screening.
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Metadata
Title
Utilization of serum D-dimer assays prior to computed tomography pulmonary angiography scans in the diagnosis of pulmonary embolism among emergency department physicians: a retrospective observational study
Authors
Leila Salehi
Prashant Phalpher
Hubert Yu
Jeffrey Jaskolka
Marc Ossip
Christopher Meaney
Rahim Valani
Mathew Mercuri
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Emergency Medicine / Issue 1/2021
Electronic ISSN: 1471-227X
DOI
https://doi.org/10.1186/s12873-021-00401-x

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