Kruger Rochelle A, du Plessis Jeanetta, Muller Henra
Department of Clinical Sciences, Faculty of Health and Environmental Sciences, Central University of Technology, Bloemfontein, South Africa.
Health SA. 2024 Dec 5;29:2620. doi: 10.4102/hsag.v29i0.2620. eCollection 2024.
Pulmonary embolism (PE), a common heart and blood vessel disease, causes complications such as haemodynamic instability and cardiovascular mortality. Timely diagnosis and treatment are imperative for managing this potentially life-threatening condition.
The aim of this study was to establish the relationship between an elevated D-dimer level and a positive computed tomography pulmonary angiogram (CTPA), which could confirm PE in patients with chest pain and suspected PE.
Data were collected at a private diagnostic radiology practice located in Bloemfontein, South Africa.
Data were retrospectively collected from the Picture Archiving and Communications System (PACS).
Of the sampled patients ( = 1219), only 16.7% were diagnosed with PE after CTPA. Approximately 14% of the D-dimer-positive patient group were diagnosed with PE and, in the D-dimer-negative patient group, approximately 20% of the patients were diagnosed with PE. Of the patients sampled, 86% were not diagnosed with PE despite having increased D-dimer values. No specific trends in the relation between elevated D-dimer levels and a positive PE diagnosis could be identified at the significance level of 0.05; a Chi-square test of independence indicated (χ [1, = 995] = 1.84, = 0.175).
No strong relationship between elevated D-dimer levels in the blood and a positive yield of PE after CTPA; was found hence, clinical decision rules for PE workups need refining, especially to limit unnecessary CTPA referrals in this setting.
The findings suggest that PE workup at the private practice should be revised to improve the quality of service.
肺栓塞（PE）是一种常见的心血管疾病，可导致血流动力学不稳定和心血管死亡等并发症。及时诊断和治疗对于管理这种潜在的危及生命的疾病至关重要。
本研究的目的是确定D-二聚体水平升高与计算机断层扫描肺血管造影（CTPA）阳性之间的关系，CTPA可确诊胸痛和疑似PE患者的PE。
数据收集于南非布隆方丹的一家私人诊断放射学诊所。
数据从图像存档与通信系统（PACS）中回顾性收集。
在抽样患者（n = 1219）中，只有16.7%在CTPA后被诊断为PE。D-二聚体阳性患者组中约14%被诊断为PE，而在D-二聚体阴性患者组中，约20%的患者被诊断为PE。在抽样患者中，86%尽管D-二聚体值升高但未被诊断为PE。在0.05的显著性水平下，未发现D-二聚体水平升高与PE阳性诊断之间的特定趋势；独立性卡方检验表明（χ[1, n = 995] = 1.84，P = 0.175）。
血液中D-二聚体水平升高与CTPA后PE的阳性检出率之间没有强相关性；因此，PE检查的临床决策规则需要完善，特别是在这种情况下限制不必要的CTPA转诊。
研究结果表明，私人诊所的PE检查应进行修订，以提高服务质量。
