Qualitative point of care D-dimer testing compared with quantitative D-dimer testing in excluding pulmonary embolism in primary care.
J Thromb Haemost. 2015 Apr 6;
Authors: Lucassen WA, Erkens PM, Geersing GJ, Büller HR, Moons KG, Stoffers HE, van Weert HC
BACKGROUND: General practitioners (GP) can safely exclude pulmonary embolism (PE) using the Wells PE-rule combined with D-dimer testing.
OBJECTIVE: To compare the accuracy of a strategy using the Wells rule combined with either a qualitative point of care (POC) D-dimer test performed in primary care or a quantitative laboratory based D-dimer test.
METHODS: We used data from a prospective cohort study including 598 adults suspected of PE in primary care in the Netherlands. GPs scored the Wells rule and carried out a qualitative POC test. All patients were referred to hospital for reference testing. We obtained quantitative D-dimer-test results as performed in hospital laboratories. The primary outcome was the prevalence of venous thrombo-embolism in low-risk patients.
RESULTS: Prevalence of PE was 12.2%. POC D-dimer-test results were available in 582 patients (97%). Quantitative test results were available in 401 patients (67%). We imputed results in 197 patients. The quantitative test and POC-test missed 1 (0.4%) and 4 patients (1.5%), respectively, with a negative strategy (Wells ≤4 points and D-dimer test negative)(p=0.20). The POC-test could exclude 23 more patients (4%)(p=0.05). The sensitivity and specificity of the Wells rule combined with a POC test was 94.5% and 51.0%, combined with a quantitative test 98.6% and 47.2%, respectively.
CONCLUSIONS: Combined with the Wells PE-rule both tests are safe in excluding PE. The quantitative test seemed to be safer than the POC test, albeit not statistically significant. The specificity of the POC test was higher resulting in more patients in whom PE could be excluded. This article is protected by copyright. All rights reserved.
PMID: 25845618 [PubMed - as supplied by publisher]