Stein Paul D, Matta Fadi, Sabra Michel J, Tana Christopher, Gough Andrew, Chabala Steve, Kakish Edward, Tworek Joseph
Department of Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, MI, USA
Department of Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, MI, USA Department of Research, St Mary Mercy Hospital, Livonia, Michigan, MI, USA.
Clin Appl Thromb Hemost. 2014 Nov;20(8):807-12. doi: 10.1177/1076029613491457. Epub 2013 Jun 6.
We assessed the prevalence of elevated quantitative latex agglutination assay for D-dimer in patients in the emergency department in whom pulmonary embolism (PE) was excluded. D-dimer was normal (<230 ng/mL) in 435 (83%) of the 522 patients. D-dimer was normal in 88% of the patients with musculoskeletal or related chest pain, 74% with pleurisy or pleuritic chest pain, and 85% with upper respiratory tract infection. D-dimer was 230 to 500 ng/mL in 65 (75%) of the 87 in whom D-dimer was elevated. Clinical probability was low in 31 (48%) of the 65 patients with D-dimer levels of 230 to 500 ng/mL. D-dimer was 230 to 500 ng/mL and clinical probability was low in 31 (36%) of the 87 patients who had computed tomographic (CT) angiograms because of elevated D-dimer. Negative likelihood ratio for PE is sufficiently low that PE can be excluded with reasonable certainty in such patients. Tailoring cutoff value to 500 ng/mL in patients with low clinical probability would have reduced CT angiograms by 36%.
我们评估了在排除肺栓塞（PE）的急诊科患者中，D - 二聚体定量乳胶凝集试验升高的患病率。522例患者中，435例（83%）的D - 二聚体正常（<230 ng/mL）。肌肉骨骼或相关胸痛患者中88%的D - 二聚体正常，胸膜炎或胸膜炎性胸痛患者中74%正常，上呼吸道感染患者中85%正常。87例D - 二聚体升高的患者中，65例（75%）的D - 二聚体为230至500 ng/mL。65例D - 二聚体水平为230至500 ng/mL的患者中，31例（48%）的临床概率较低。因D - 二聚体升高而行计算机断层扫描（CT）血管造影的87例患者中，31例（36%）的D - 二聚体为230至500 ng/mL且临床概率较低。PE的阴性似然比足够低，以至于在此类患者中可以相当确定地排除PE。将临床概率低的患者的临界值调整为500 ng/mL可使CT血管造影减少36%。
