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Application of a decision rule and a D-dimer assay in the diagnosis of pulmonary embolism
| Content Provider | Scilit |
|---|---|
| Author | Douma, Renee A. Squizzato, Alessandro Sohne, Maaike Buller, Harry R. Gibson, Nadine S. |
| Editor | Gerdes, Victor E. A. |
| Copyright Year | 2010 |
| Description | Summary Current strategies for diagnosing pulmonary embolism (PE) include a clinical decision rule (CDR), followed by a D-dimer assay in patients with an unlikely clinical probability. We assessed the implementation of the current guidelines for the diagnosis of PE. A first questionnaire was sent to internists and pulmonologists to assess the proportion of physicians that adequately applied the guidelines. Two versions of a second questionnaire were sent presenting five hypothetical cases of which in two cases with an intermediate clinical probability an abnormal D-dimer test result was added to one version. We assessed the variation of the CDR and compared the proportions of a likely clinical probability between the two versions. A total of 65 physicians responded to the first questionnaire (response rate 75%). Half of the physicians (N=29; 46%) indicated that they use a CDR in all patients and 22 physicians (45%) indicated that they review the D-dimer result after they examined patients. Sixty-two physicians responded on the second questionnaire (response rate 36%). A shift was observed from an unlikely to a likely probability when an abnormal D-dimer test result was added to the clinical information (22% to 41%; p=0.22 and 26% to 50%; p<0.05). Our findings indicate that physicians do not use the guidelines for diagnosis of PE consistently. Furthermore, the knowledge of an abnormal D-dimer test result before seeing the patient leads to a higher CDR score. Physicians should therefore first examine patients before taking note of the D-dimer test result. |
| Related Links | http://pdfs.semanticscholar.org/f761/545128513306228abc8ef2288c7ce05ca6f9.pdf http://www.thieme-connect.de/products/ejournals/pdf/10.1160/TH08-09-0564.pdf |
| Ending Page | 854 |
| Page Count | 6 |
| Starting Page | 849 |
| ISSN | 2567689X |
| DOI | 10.1160/th08-09-0564 |
| Journal | Thrombosis and Haemostasis |
| Issue Number | 04 |
| Volume Number | 103 |
| Language | English |
| Publisher | Georg Thieme Verlag KG |
| Publisher Date | 2010-01-01 |
| Access Restriction | Open |
| Subject Keyword | Journal: Thrombosis and Haemostasis Medical Laboratory Technology Diagnosis of Pe Guidelines for the Diagnosis |
| Content Type | Text |
| Resource Type | Article |
| Subject | Hematology |
