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Is pretest probability assessment on emergency department patients with suspected venous thromboembolism documented before SimpliRED ᴅ-dimer testing?
Published online by Cambridge University Press: 21 May 2015
Abstract
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Background:
The SimpliRED ᴅ-dimer assay is commonly ordered by emergency physicians for suspected pulmonary embolus or deep venous thrombosis. A pretest probability (PTP) assessment is required for the results of this diagnostic test to be interpreted correctly and applied appropriately. Without this assessment, the physician may misinterpret the test results and proceed to unnecessary diagnostic imaging (DI) or inappropriate discharge. Our objectives were to measure the documentation rate of PTP for emergency department (ED) patients on whom a SimpliRED ᴅ-dimer assay was performed for suspected venous thromboembolism (VTE) and to determine if the clinical management decisions that followed were in keeping with current recommendations.
Methods:
In this medical record review, we used a random number generator to select 100 charts from all 760 patients who had a SimpliRED ᴅ-dimer performed during a 3-month period at an academic tertiary care centre with 3 EDs. Trained data abstractors, blinded to the study hypothesis, abstracted explicitly defined data from each chart. An independent abstractor assessed the reliability of 15 of the charts that were randomly chosen.
Results:
Suspicion of VTE was documented in 97 of the 100 charts. There was no documentation of PTP assessment for 62 of the 97 cases. Ten had a positive ᴅ-dimer but 5 of these had no evidence of subsequent DI. Of the 97 charts reviewed, 24 documented decisions were in discordance with published clinical management recommendations for VTE.
Conclusion:
In the majority of ED cases of suspected VTE, PTP assessment was not documented and approximately one-quarter of these documented decisions were in discordance with established recommendations for the given test results. This suggests that PTP assessments are not being conducted in a significant proportion of cases and the diagnostic test results are misinterpreted, applied incorrectly or both.
Keywords
- Type
- Original Research • Recherche originale
- Information
- Copyright
- Copyright © Canadian Association of Emergency Physicians 2008
References
1.Wells, PS, Anderson, DR, Rodger, M, et al.Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 2003;349:1227–35.CrossRefGoogle ScholarPubMed
2.Kline, JA, Webb, WB, Jones, AE, et al.Impact of a rapid rule-out protocol for pulmonary embolism on the rate of screening, missed cases, and pulmonary vascular imaging in an urban US emergency department. Ann Emerg Med 2004;44:490–502.Google Scholar
3.Wells, PS, Anderson, DR, Rodger, M, et al.Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and D-dimer. Ann Intern Med 2001;135:98–107.CrossRefGoogle Scholar
4.Worster, A, Haines, T. Advance statistics: medical record review (MRR) studies. Acad Emerg Med 2004;11:187–92.CrossRefGoogle ScholarPubMed
5.Tillie-Leblond, I, Marquette, CH, Perez, T, et al.Pulmonary embolism in patients with unexplained exacerbation of chronic obstructive pulmonary disease: prevalence and risk factors. Ann Intern Med 2006;144:390–6.CrossRefGoogle ScholarPubMed
6.Wells, PS, Brill-Edwards, P, Stevens, P, et al.A novel and rapid whole-blood assay for D-dimer in patients with clinically suspected deep vein thrombosis. Circulation 1995;91:2184–7.CrossRefGoogle ScholarPubMed
7.Freyburger, G, Trillaud, H, Labrouche, S, et al.D-dimer strategy in thrombosis exclusion — a gold standard study in 100 patients suspected of deep venous thrombosis or pulmonary embolism: 8 DD methods compared. Thromb Haemost 1998;79:32–7.Google Scholar
8.Brill-Edwards, P, Lee, A. D-dimer testing in the diagnosis of acute venous thromboembolism. Thromb Haemost 1999;82:688–94.Google ScholarPubMed
9.Goldstein, NM, Kollef, MH, Ward, S, et al.The impact of the introduction of a rapid D-dimer assay on the diagnostic evaluation of suspected pulmonary embolism. Arch Intern Med 2001;161:567–71.CrossRefGoogle ScholarPubMed
10.Kline, JA, Nelson, RD, Jackson, RE, et al.Criteria for the safe use of D-dimer testing in emergency department patients with suspected pulmonary embolism: a multicenter United States study. Ann Emerg Med 2002;39:144–52.CrossRefGoogle Scholar
11.Wells, PS, Ginsberg, JS, Anderson, DR, et al.Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med 1998;129:997–1005.CrossRefGoogle ScholarPubMed
12.Runyon, MS, Richman, PB, Kline, JA. Emergency medicine practitioner knowledge and use of decision rules for the evaluation of patients with suspected pulmonary embolism: variations by practice setting and training level. Acad Emerg Med 2007;14:53–7.CrossRefGoogle ScholarPubMed
13.Roy, PM, Meyer, G, Vielle, B, et al.Appropriateness of diagnostic management and outcomes of suspected pulmonary embolism. Ann Intern Med 2006;144:157–64.CrossRefGoogle ScholarPubMed
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