Simplified Diagnostic Strategy Evaluates Pulmonary Embolism

Study finds D-dimer testing and computed tomography as effective as other strategies

TUESDAY, Jan. 10 (HealthDay News) -- A simplified algorithm using D-dimer testing and computed tomography (CT) effectively evaluates patients with suspected pulmonary embolism and its use is associated with a low risk of subsequent fatal or non-fatal venous thromboembolism (VTE), according to a study published in the Jan. 11 issue of the Journal of the American Medical Association.

Menno V. Huisman, M.D., of Leiden University Medical Center in Leiden, the Netherlands, and colleagues studied 3,306 patients with suspected acute pulmonary embolism. Patients categorized as unlikely to have pulmonary embolism had D-dimer testing and pulmonary embolism was considered excluded if the D-dimer test result was normal. All other patients underwent CT.

The researchers found that the combination of "unlikely" status and a normal D-dimer test result occurred in 1,057 patients (32%), most of whom were not treated with anticoagulants. Subsequent nonfatal VTE occurred in five patients (0.5%). Computed tomography confirmed a pulmonary embolism in 674 patients (20.4%) and excluded pulmonary embolism in 1,505 patients, most of whom were not treated with anticoagulants. In these patients, the investigators found that the three-month incidence of VTE was 1.3%. Pulmonary embolism was considered a possible cause of death in seven patients (0.5%) after a negative CT scan.

"A diagnostic management strategy using a simple clinical decision rule, D-dimer testing, and CT is as effective as other more complex diagnostic strategies in the evaluation and management of patients with clinically suspected pulmonary embolism," the authors conclude.

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