Here is a common scenario: The resident presents a case of a 58 yo patient who has presented with shortness of breath. They go over the examination, the ECG findings and then say “…. and the D-Dimer was….” Your next question may be, “Why did you do a D-dimer? Were you suspicious for a pulmonary embolism(PE)? What’s the Well’s Score, what’s your pretest probability?……..” (15 minutes reading)
Does just doing a D-dimer on its own help make or exclude the diagnosis and does it result in less imaging?
This study(1) looked at a D-Dimer-only pathway (ie., no clinical prediction rules), with the objective of reducing the number of patients receiving imaging.
What They Did
This was a prospective, multicenter implementation study, conducted in three public Canadian Emergency Departments. One of the three departments was used as the control.
The PE testing pathway used, consisted of D-dimer testing. If the D-dimer level was > 500 ng/ mL, a CTPA or VQ scan was performed. If the D-dimer level was less than 500 ng/mL, PE was excluded. Clinicians were permitted to make alternative diagnoses and not perform imaging, even if the d-dimer was high.
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