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  • Title: Radiologic diagnoses of patients who received imaging for venous thromboembolism despite negative D-dimer tests.
    Author: Nordenholz KE, Zieske M, Dyer DS, Hanson JA, Heard K.
    Journal: Am J Emerg Med; 2007 Nov; 25(9):1040-6. PubMed ID: 18022499.
    Abstract:
    OBJECTIVE: The literature supports a negative D-dimer (-DD) excluding venous thromboembolic disease (VTE) in low-risk patients. We determined the radiologic diagnoses in patients where imaging was ordered despite a -DD. METHODS: This is a retrospective chart review of patients with a -DD (Tinaquant; Roche Diagnostics, Mannheim, Germany) and a radiologic study within 48 hours, sought to determine radiologic diagnosis (primary outcome), treatment of VTE, and consensus diagnosis of acute VTE. RESULTS: Among 3462 DD tests, 1678 met the inclusion criteria. Of 1362 patients with DD values of 350 ng/mL or less, 166 (12.2%) had radiologic studies: 93.4% of the final radiologic diagnoses were negative for VTE, 3.6% were indeterminate, and 3.0% (1.0%-6.9%) were positive; 1.8% ultimately had a consensus diagnosis of acute VTE. In 316 patients with DD values between 351 and 500 ng/mL, 88 (27.8%) had radiologic studies: 95.5% were negative, 1.1% were indeterminate, and 3.4% (0.7%-9.6%) were positive. CONCLUSIONS: Of patients who receive radiologic studies despite -DD tests, 3.0% have positive radiologic diagnoses for acute VTE; only 1.8% had acute VTE after the review of their hospital course.
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