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Clinical pre‐test probability adjusted versus age‐adjusted D‐dimer interpretation strategy for DVT diagnosis: A diagnostic individual patient data meta‐analysis
Author(s) -
Parpia Sameer,
Takach Lapner Sarah,
Schutgens Roger,
Elf Johan,
Geersing GeertJan,
Kearon Clive
Publication year - 2020
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.14718
Subject(s) - medicine , confidence interval , bivariate analysis , meta analysis , d dimer , pre and post test probability , age adjustment , statistics , epidemiology , mathematics
Background To increase the clinical usefulness of the D‐dimer test in diagnosis of deep vein thrombosis (DVT), two strategies have been proposed: the age‐adjusted, and the clinical pre‐test probability (CPTP) adjusted interpretation. However, it is not known which of these strategies is superior. Objective To conduct an individual patient data (IPD) meta‐analysis that compares the sensitivity, specificity, negative predictive value (NPV), and utility (the proportion of all patients who have a negative D‐dimer test) when the two strategies are used to interpret D‐dimer results. Methods Using an established IPD database, we conducted a meta‐analysis to compare the two strategies. A bivariate random effects regression model was used to estimate and compare the pooled sensitivity and specificity simultaneously. The pooled NPV and utility of the two strategies was compared using a univariate random effects model. Results Four studies were eligible for this analysis, with a total of 2554 patients. Overall prevalence of DVT was 12% with substantial heterogeneity between studies ( P value < .001). Both strategies have high pooled NPVs (99.8%) with a difference of 0% (95% confidence interval [CI]: −0.1, 0.1). The difference between the pooled specificity of the CPTP‐adjusted strategy (57.3%) and the age‐adjusted strategy (54.7%) was 2.6% (95% CI: −7.7, 12.8). The CPTP‐adjusted strategy (49.4%) has a marginally greater pooled utility compared with the age‐adjusted approach (47.4%), with a pooled difference of 1.9% (95% CI: −0.1, 3.9). Conclusions Both D‐dimer interpretation strategies were associated with a high and similar NPV, and similar utility.