Emergency Department Pulmonary Embolism D-Dimer Screening Not Following Guidelines

NEW YORK, June 17, 2009 — Despite established clinical guidelines that suggest how D-dimer testing results should guide computed tomography (CT) evaluation of patients with suspected pulmonary emboli (PE), emergency department (ED) use of such testing is not well standardized, according to researchers.

"Any time a patient gets a CT scan there is a radiation dose," lead investigator Dr Michael T. Corwin said in a statement. "The evaluation of patients with suspected PE should include D-dimer and CT testing in a more standardized fashion so that we can save patients from having unnecessary CT scans."

Dr Corwin et al at the Warren Alpert Medical School of Brown University and Rhode Island Hospital in Providence, noted in the May issue of the American Journal of Roentgenology that in current accepted clinical practice, in patients with low clinical probability for PE, a D-dimer test is performed; if it is negative, the patient has no further workup. If it is positive, patients have a CT.

The researchers retrospectively reviewed data on more than 5300 patients who underwent either a D-dimer test or a multidetector CT (MDCT) examination.

"42% of patients had a positive D-dimer exam[ination] and did not have a CT scan," Dr Corwin stated. "Current protocols suggest that those patients should have had a scan.

"MDCT was performed in 7% of patients with negative D-dimer results, and the same protocols suggest that those patients should not have undergone a scan," he added.

"Our study shows that the evaluation of ED patients for the diagnosis of pulmonary embolism does not follow established clinical guidelines," Dr Corwin told Reuters Health.

He added, "We hope that our results bring awareness to this and lead to stricter adherence to these guidelines. This is turn, may reduce the number of unnecessary CT examinations, thereby reducing the radiation exposure to these patients."

Source: Reuters Health Information