Goldstein N M, Kollef M H, Ward S, Gage B F
Campus Box 8052, Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA.
Arch Intern Med. 2001 Feb 26;161(4):567-71. doi: 10.1001/archinte.161.4.567.
Rapid D-dimer assays are being used in the diagnostic evaluation of suspected pulmonary embolism (PE). Although this hypothesis is anticipated to decrease the use of ventilation-perfusion (VQ) scans and other diagnostic tests for PE, it has not been tested in a "real-world" environment.
A randomized prospective trial was conducted on 470 of the 5390 enrolled patients aged 60 years and older who had previously undergone any diagnostic tests for PE at an urban teaching hospital. The use of D-dimer as part of the diagnostic evaluation for PE was promulgated in the 2 randomly chosen intervention firms. The remaining 2 firms served as controls.
The number of VQ scans, spiral computed tomographic scans, and pulmonary angiograms performed. Secondary outcomes included mortality and thromboembolic or bleeding events during 3 months of follow-up.
Of the 470 inpatients who underwent evaluation for PE on a per PE workup basis, fewer VQ scans were performed in the intervention firms (63.8% vs 81.3%; P<.01). However, the number of patients evaluated for PE nearly doubled in the intervention firms (304 vs 166; P<.01), so that more VQ scans were performed in the intervention than in the control firms (194 vs 135; P<.01). Ninety-four patients from the control firms and 160 patients from the intervention firms were diagnosed and treated for venous thromboembolic disease (P<.01). There were no differences in secondary outcomes during the 3-month follow-up.
The introduction of a rapid D-dimer assay increased the number of VQ scans performed because the number of patients screened for PE increased. A larger number of patients in the intervention firms were diagnosed as having venous thromboembolic disease (PE and/or deep vein thrombosis). There were no perceived changes in mortality or venous thromboembolic events during the 3-month follow-up.
快速D-二聚体检测正用于疑似肺栓塞（PE）的诊断评估。尽管预计这一假说会减少通气-灌注（V/Q）扫描及其他PE诊断检查的使用，但尚未在“真实世界”环境中进行检验。
对一家城市教学医院中5390名60岁及以上且此前接受过任何PE诊断检查的入选患者中的470名进行了一项随机前瞻性试验。在随机选取的2个干预科室中推行将D-二聚体作为PE诊断评估的一部分。其余2个科室作为对照。
进行的V/Q扫描、螺旋计算机断层扫描及肺血管造影的数量。次要结局包括随访3个月期间的死亡率以及血栓栓塞或出血事件。
在按每次PE检查对470名住院患者进行评估时，干预科室进行的V/Q扫描较少（63.8%对81.3%；P<0.01）。然而，干预科室接受PE评估的患者数量几乎翻倍（304对166；P<0.01），因此干预科室进行的V/Q扫描比对照科室更多（194对135；P<0.01）。对照科室的94名患者和干预科室的160名患者被诊断并接受了静脉血栓栓塞性疾病的治疗（P<0.01）。在3个月的随访期间，次要结局没有差异。
引入快速D-二聚体检测增加了V/Q扫描的执行数量，因为筛查PE的患者数量增加了。干预科室中有更多患者被诊断为患有静脉血栓栓塞性疾病（PE和/或深静脉血栓形成）。在3个月的随访期间，未观察到死亡率或静脉血栓栓塞事件有明显变化。
