Evaluation of D-Dimer Testing Sensitivity and Specificity in Emergency Medicine

13 Pages Posted: 29 Oct 2013

See all articles by Sayed Ebrahim

Sayed Ebrahim

Jackson Park Hospital

Bahareh Shafaei

Jackson Park Hospital; University of Ottawa

Amindeep Lail

Jackson Park Hospital

Jennifer Ingersoll

Jackson Park Hospital

Pratap Kumar

Jackson Park Hospital

Date Written: August 27, 2013

Abstract

Background: The negative value of the D-dimer test has been widely used to rule out thrombotic disorders such as Pulmonary Embolism (PE) and Deep Venous Thrombosis (DVT).

Aims: The present study was to evaluate the efficacy of the D-dimer cut-off values based on the patients’ medical history, symptoms, clinical diagnosis, age and gender, and to correlate the D-dimer value with the necessity of utilizing cost-effective investigations for diagnosing suspected thrombotic disorders.

Materials and Methods: Prospective study of 352 patients over 3 consecutive months was conducted.

Results: Overall 57.7% of patients had positive D-Dimer values out of which 20.7% were presented with chief complaint of chest pain, 14.8% with Shortness of breath, 7.7% complained of dizziness, 4.5% presented with extremity pain, 4.3% with abdominal pain, 4.3% with flu-like symptoms and cough, and 1.4% presented with alcohol intoxication with non specific complaints. Majority of patients were ultimately diagnosed with non specific chest pain, CHF, respiratory disorders, musculoskeletal disorders, etc. Only 3.125% of patients with positive d-dimer values were diagnosed with either PE or DVT.

Conclusion: Low sensitivity and low positive predictive value have strongly suggested an elevated D-dimer neither indicates a specific disease nor has a strong correlation with the clinical severity of the disease. Slight elevation of D-dimer can be justified based on race, age, gender, medical history, initial presentation of patient and clinical diagnosis, and should not cloud the clinical judgment, exposing the patient to redundant and costly investigations.

Keywords: D-dimer, DVT, Pulmonary embolism, Sensitivity, Specificity, Thrombotic disorders

JEL Classification: I12

Suggested Citation

Ebrahim, Sayed and Shafaei, Bahareh and Lail, Amindeep and Ingersoll, Jennifer and Kumar, Pratap, Evaluation of D-Dimer Testing Sensitivity and Specificity in Emergency Medicine (August 27, 2013). Available at SSRN: https://ssrn.com/abstract=2345896 or http://dx.doi.org/10.2139/ssrn.2345896

Sayed Ebrahim

Jackson Park Hospital ( email )

7531 Stony Island Avenue
Chicago, IL 60649
United States

Bahareh Shafaei (Contact Author)

Jackson Park Hospital ( email )

7531 Stony Island Avenue
Chicago, IL 60649
United States

University of Ottawa ( email )

2292 Edwin Crescent
Ottawa, Ontario K2C 1H7
Canada

Amindeep Lail

Jackson Park Hospital ( email )

7531 Stony Island Avenue
Chicago, IL 60649
United States

Jennifer Ingersoll

Jackson Park Hospital ( email )

7531 Stony Island Avenue
Chicago, IL 60649
United States

Pratap Kumar

Jackson Park Hospital ( email )

7531 Stony Island Avenue
Chicago, IL 60649
United States

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