Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Arch Dis Child. 2018 Sep;103(9):832-834. doi: 10.1136/archdischild-2017-313315. Epub 2017 Nov 8.
We sought to measure the diagnostic accuracy of D-dimer in children with suspected pulmonary embolism (PE).
We queried our electronic medical record for quantitative D-dimer values obtained in all children ages 5-17 over 10 years in our 10-hospital system. Patients who had a D-dimer obtained in the evaluation of PE underwent supervised chart review to extract baseline demographics (age, sex, ethnicity), medical history, laboratory data and imaging results. PE was confirmed by imaging positive for deep vein thrombosis (DVT) or PE and excluded by imaging or no DVT or PE diagnosis within 90 days.
Over a 10-year period, we identified 13 792 orders for D-dimer testing in 2554 unique patients. Chart review indicated that 526 (20.6%) unique patients had D-dimer testing performed in the evaluation of PE (Cohen's kappa=0.95, 95% CI 0.85 to 1.0). Most D-dimers (465/526, 88%) were ordered in children aged >12 years. Of these 526 children, 34 (6.4%, 95% CI) had a criterion standard positive for new or recurrent PE. The mean D-dimer value was 2104±1394 ng/mL in the 34/34 PE+ children and 586±962 ng/mL in PE- children with a sensitivity of 34/34 (100%, 89% to 100%) and a specificity of 290/492 (58%, 54% to 63%). The area under the receiver operating characteristic curve was 0.90 ((0.9)87-0.94).
D-dimer is currently ordered in children for suspected PE in the emergency care setting, mostly in teenagers. The observed lower limit 95% CIs of 89% and 54% for diagnostic sensitivity and the specificity, respectively, suggest if used in patients with low-clinical probability, a normal D-dimer can safely exclude PE in children.
我们旨在测量 D-二聚体在疑似肺栓塞（PE）儿童中的诊断准确性。
我们在电子病历中查询了我们的 10 家医院系统中 10 年来所有 5-17 岁儿童的定量 D-二聚体值。在评估 PE 时获得 D-二聚体的患者接受了监督图表审查，以提取基线人口统计学数据（年龄、性别、种族）、病史、实验室数据和影像学结果。通过影像学检查证实深静脉血栓形成（DVT）或 PE 呈阳性，并在 90 天内通过影像学检查或无 DVT 或 PE 诊断排除 PE。
在 10 年期间，我们在 2554 名患者中确定了 13792 次 D-二聚体检测订单。图表审查表明，526（20.6%）名独特患者在评估 PE 时进行了 D-二聚体检测（Cohen's kappa=0.95，95%CI 0.85-1.0）。大多数 D-二聚体（465/526，88%）是在年龄大于 12 岁的儿童中订购的。在这 526 名儿童中，34 名（6.4%，95%CI）有新的或复发性 PE 的标准阳性。34/34PE+儿童的平均 D-二聚体值为 2104±1394ng/ml，PE-儿童的平均 D-二聚体值为 586±962ng/ml，敏感性为 34/34（100%，89%-100%），特异性为 290/492（58%，54%-63%）。受试者工作特征曲线下面积为 0.90（0.9）87-0.94。
D-二聚体目前在急诊环境中用于疑似 PE 的儿童，主要是青少年。观察到诊断敏感性的下限 95%CI 分别为 89%和 54%，特异性分别为 58%和 54%，表明如果在低临床可能性的患者中使用，正常的 D-二聚体可以安全地排除儿童中的 PE。
