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Tandem Measurement of D‐dimer and Myeloperoxidase or C‐reactive Protein to Effectively Screen for Pulmonary Embolism in the Emergency Department
Author(s) -
Mitchell Alice M.,
Nordenholz Kristen E.,
Kline Jeffrey A.
Publication year - 2008
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.1553-2712.2008.00204.x
Subject(s) - medicine , d dimer , pulmonary embolism , emergency department , myeloperoxidase , confidence interval , c reactive protein , thrombosis , gastroenterology , deep vein , prospective cohort study , inflammation , psychiatry
Objectives: The hypothesis was that the tandem measurement of D‐dimer and myeloperoxidase (MPO) or C‐reactive protein (CRP) could significantly decrease unnecessary pulmonary vascular imaging in emergency department (ED) patients evaluated for pulmonary embolism (PE) compared to D‐dimer alone. Methods: The authors measured the sequential combinations of D‐dimer and MPO and D‐dimer and CRP in a prospective sample of ED patients evaluated for PE at two centers. Patients were followed for 90 days for venous thromboembolism (VTE, either PE or deep venous thrombosis [DVT]), which required the consensus of two of three blinded physician reviewers. Results: The authors enrolled 304 patients, 22 with VTE (7%; 95% confidence interval [CI] = 5% to 10%). The sensitivity and specificity of a D‐dimer alone (cutoff ≥ 500 ng/mL) were 100% (95% CI = 85% to 100%) and 59% (95% CI = 53% to 65%), respectively, and was followed by pulmonary vascular imaging negative for PE in 38% (115/304; 95% CI = 32% to 44%). The combination of either a negative D‐dimer, or MPO < 22 mg/dL, had a sensitivity of 100% and specificity of 73% (95% CI = 67% to 78%). Thus, tandem measurement of D‐dimer and MPO would have decreased the frequency of subsequent negative pulmonary vascular imaging from 38% to 25% (95% CI of the difference of −13% = −5% to −20%). The combination of CRP and D‐dimer would not have significantly improved the rate of negative imaging. Conclusions: The tandem measurement of D‐dimer and MPO would have significantly decreased negative pulmonary vascular imaging compared with D‐dimer alone and should be validated prospectively.