Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability

Among patients with a low clinical pretest probability of pulmonary embolism and a d -dimer level of less than 1000 ng per milliliter (twice the usual threshold used to rule out the disorder), the need for diagnostic imaging was reduced from 51.9% to 34.3% of patients, without increasing the risk of...

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Bibliographic Details
Published inThe New England journal of medicine Vol. 381; no. 22; pp. 2125 - 2134
Main Authors Kearon, Clive, de Wit, Kerstin, Parpia, Sameer, Schulman, Sam, Afilalo, Marc, Hirsch, Andrew, Spencer, Frederick A, Sharma, Sangita, D’Aragon, Frédérick, Deshaies, Jean-François, Le Gal, Gregoire, Lazo-Langner, Alejandro, Wu, Cynthia, Rudd-Scott, Lisa, Bates, Shannon M, Julian, Jim A
Format Journal Article
LanguageEnglish
Published United States Massachusetts Medical Society 28.11.2019
Subjects
Adult
Aged
Algorithms
Angiography
Anticoagulants
Chest
Clinical Decision Rules
Computed tomography
Computed Tomography Angiography
Consent
Diagnosis
Diagnostic tests
Embolism
Embolisms
Enrollments
Female
Fibrin Fibrinogen Degradation Products - analysis
Health risk assessment
Humans
Male
Medical diagnosis
Medical imaging
Medical research
Middle Aged
Patients
Predictive Value of Tests
Probability
Prospective Studies
Pulmonary Embolism - blood
Pulmonary Embolism - diagnosis
Pulmonary Embolism - diagnostic imaging
Pulmonary embolisms
Thromboembolism
Canada
North America
Europe
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Summary:Among patients with a low clinical pretest probability of pulmonary embolism and a d -dimer level of less than 1000 ng per milliliter (twice the usual threshold used to rule out the disorder), the need for diagnostic imaging was reduced from 51.9% to 34.3% of patients, without increasing the risk of missing the diagnosis of pulmonary embolism.
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ISSN:0028-4793
1533-4406
1533-4406
DOI:10.1056/NEJMoa1909159