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A Highly Sensitive ELISA D‐Dimer Increases Testing but Not Diagnosis of Pulmonary Embolism
Author(s) -
Kabrhel Christopher,
Matts Christina,
McNamara Mariah,
Katz Jeremy,
Ptak Thomas
Publication year - 2006
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 - 10.1197/j.aem.2005.12.012
Subject(s) - medicine , pulmonary embolism , d dimer , emergency department , nuclear medicine , surgery , psychiatry
Objectives:To determine the effect of introducing a rapid enzyme‐linked immunosorbent assay (ELISA) D‐dimer on the percentage of emergency department (ED) patients evaluated for pulmonary embolism (PE), the use of associated laboratory testing, pulmonary vascular imaging, and the diagnoses of PE.Methods:Patients evaluated for PE during three 120‐day periods were enrolled: immediately before (period 1), immediately after (period 2), and one year after the introduction of a rapid ELISA D‐dimer in the hospital. The frequency of ED patients evaluated for PE with any test, with D‐dimer testing, and with pulmonary vascular imaging and the frequency of PE diagnosis during each time period were determined.Results:The percentage of patients evaluated for PE nearly doubled; from 1.36% (328/24,101) in period 1 to 2.58% (654/25,318) in period 2 and 2.42% (583/24,093) in period 3. The percentage of patients who underwent D‐dimer testing increased more than fourfold; from 0.39% (93/24,101) in period 1 to 1.83% (464/25,318) in period 2 and 1.77% (427/24,093) in period 3. The percentage of patients who underwent pulmonary vascular imaging increased from 1.02% (247/24,101) in period 1 to 1.36% (344/25,318) in period 2 and to 1.39% (334/24,093) in period 3. There was no difference in the percentage of patients diagnosed as having PE in period 1 (0.20% [47/24,101]), period 2 (0.27% [69/25,318]), and period 3 (0.24% [58/24,093]).Conclusions:In the study's academic ED, introduction of ELISA D‐dimer testing was accompanied by an increase in PE evaluations, D‐dimer testing, and pulmonary vascular imaging; there was no observed change in the rate of PE diagnosis.