Evaluation of D-Dimer Testing Sensitivity and Specificity in Emergency Medicine
13 Pages Posted: 29 Oct 2013
Date Written: August 27, 2013
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: Suggested Citation