Article type
Year
Abstract
Background: Clinicians in outpatient clinics and emergency departments desire to have an accurate quantitative D-dimer assay.
Objective: The study objective was to evaluate the diagnostic performance characteristics of the latex turbidimetric D-dimer test in the diagnosis of pulmonary embolism (PE) in the emergency department population.
Methods: A search of MEDLINE, EMBASE and bibliographies of previous systematic reviews was conducted with no language restriction. Experts in the field of PE research were contacted in order to identify unpublished studies. Prospective investigations involving a predominately outpatient population suspected of PE that used a turbidimetric D-dimer test were included. Two authors extracted data independently and assessed study quality based on the composition of the patient spectrum and the reference standard used. Consensus was reached by conference. The analysis was based on a summary receiver operating characteristic (SROC) curve and combining sensitivity and specificity independently across studies using a random-effects model.
Results: The search yielded 264 publications and 2 unpublished studies. Nine studies met the inclusion criteria and provided a sample of 1,901 subjects. Eight of the nine studies were homogeneous in terms of both sensitivity and specificity. One study has similar sensitivity but higher specificity. Combining the studies yielded an overall sensitivity of 0.93 (95% CI: 0.89, 0.96), and an overall specificity of 0.51 (95% CI: 0.42, 0.59). The SROC curve provides a graphical display of the results (Figure).
Conclusion: The turbidimetric D-dimer test is sensitive but non-specific for the detection of PE in the emergency department setting. D-dimer tests using latex turbidimetric methods appear to have comparable test characteristics to those using ELISA methods.
Objective: The study objective was to evaluate the diagnostic performance characteristics of the latex turbidimetric D-dimer test in the diagnosis of pulmonary embolism (PE) in the emergency department population.
Methods: A search of MEDLINE, EMBASE and bibliographies of previous systematic reviews was conducted with no language restriction. Experts in the field of PE research were contacted in order to identify unpublished studies. Prospective investigations involving a predominately outpatient population suspected of PE that used a turbidimetric D-dimer test were included. Two authors extracted data independently and assessed study quality based on the composition of the patient spectrum and the reference standard used. Consensus was reached by conference. The analysis was based on a summary receiver operating characteristic (SROC) curve and combining sensitivity and specificity independently across studies using a random-effects model.
Results: The search yielded 264 publications and 2 unpublished studies. Nine studies met the inclusion criteria and provided a sample of 1,901 subjects. Eight of the nine studies were homogeneous in terms of both sensitivity and specificity. One study has similar sensitivity but higher specificity. Combining the studies yielded an overall sensitivity of 0.93 (95% CI: 0.89, 0.96), and an overall specificity of 0.51 (95% CI: 0.42, 0.59). The SROC curve provides a graphical display of the results (Figure).
Conclusion: The turbidimetric D-dimer test is sensitive but non-specific for the detection of PE in the emergency department setting. D-dimer tests using latex turbidimetric methods appear to have comparable test characteristics to those using ELISA methods.