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Utility of an Initial D‐dimer Assay in Screening for Traumatic or Spontaneous Intracranial Hemorrhage
Author(s) -
Hoffmann Mark E.,
Ma O. John,
Gaddis Gary
Publication year - 2001
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2001.tb01145.x
Subject(s) - medicine , subarachnoid hemorrhage , d dimer , hematoma , intraparenchymal hemorrhage , computed tomography , head trauma , subdural hemorrhage , confidence interval , emergency department , radiology , intracranial hemorrhages , nuclear medicine , surgery , psychiatry
Objective: To evaluate the sensitivity of a D‐dimer assay as a screening tool for possible traumatic or spontaneous intracranial hemorrhage. If adequately sensitive, the D‐dimer assay may potentially permit omission of a more expensive computed tomography (CT) scan of the head when such hemorrhage is clinically suspected. Methods: Prospective, consecutive, blinded study of patients (age > 16 years) requiring a CT scan of the head for suspected intracranial hemorrhage over a five‐month period at a university, Level I trauma center. All study patients had a serum D‐dimer assay obtained prior to their CT scans. Sensitivity and specificity, with 95% confidence intervals (95% CIs), of the enzyme‐linked immunosorbent assay (ELISA) D‐dimer assay for the detection of intracranial hemorrhage were calculated. Results: Of the 319 patients entered in the study, 25 (7.8%) had a CT scan positive for intracranial hemorrhage. Patients with intracranial hemorrhage were more likely to have a positive D‐dimer assay (chi‐square ? 13.075, p < 0.001). The D‐dimer assay had 21 true‐positive and four false‐negative tests, resulting in a sensitivity of 84.0% (95% CI ? 63.7% to 95.5%) and a specificity of 55.8% (95% CI ? 55.5% to 55.9%). The four false‐negative cases included one small intraparenchymal hemorrhage, one small subarachnoid hemorrhage, one moderate‐sized intraparenchymal hemorrhage with mid‐line shift, and one large subdural hematoma requiring emergent surgery. Conclusions: Due to the catastrophic nature of missing an intracranial hemorrhage in the emergency department, the D‐dimer assay is not adequately sensitive or predictive to use as a screening tool to allow routine omission of head CT scanning.