Abstract
Background
D-dimer testing rules out deep vein thrombosis (DVT) and pulmonary embolism (PE) in
low-risk emergency department (ED) patients. Most research has measured fibrin-equivalent
units (FEUs), however, many laboratories measure D-dimer units (DDUs).
Objective
Our aim was to determine whether either DDU measurements or FEU measurements can rule
out DVT/PE using traditional or age-related cutoff values.
Methods
We performed a de-identified multicenter retrospective evaluation of D-dimer in nonpregnant
adult ED patients to evaluate for DVT/PE. DDUs were multiplied by 2 to determine equivalent
FEUs prior to analysis. Sensitivity measurements for D-dimer were calculated for FEUs,
DDUs, combined FEU/DDUs, and multiple age-adjusted values.
Results
We identified 47,088 ED patients with a D-dimer laboratory value (27,307 FEUs/19,781
DDUs) and 1623 DVT/PEs. The median combined FEU/DDU D-dimer was 400 ng/mL FEUs (interquartile
range [IQR] 300–900 ng/mL FEUs) for patients without a DVT/PE vs 2530 ng/mL FEU (IQR
1094–6000 ng/mL FEUs) with a DVT/PE (p < 0.001), overall sensitivity of 87.3% (95% confidence interval [CI] 87.0–87.6%)
and negative predictive value of 99.3% (95% CI 99.2–99.4%). Individually, FEUs performed
better than DDUs, with sensitivities of 88.0% (95% CI 85.8–89.9%) and 86.1% (95% CI
83.1–88.7%), respectively; however, this difference was not statistically significant.
Combined age-adjusted performance had a sensitivity of 90.3% (95% CI 88.3–92.0%);
however, a new DDU-only age-adjusted criteria had the highest sensitivity of 91.1%
(95% CI 87.9–93.6%).
Conclusions
Our undifferentiated D-dimer measurements had a slightly lower sensitivity to rule
out DVT/PE than reported previously. Our data support using either DDU or FEU measurements
for all ages or when using various age-adjusted criteria to rule out DVT/PE.
Keywords
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Article Info
Publication History
Published online: April 30, 2022
Accepted:
April 23,
2022
Received in revised form:
February 14,
2022
Received:
October 10,
2021
Footnotes
☆ Portions of the data were presented at the Society for Academic Emergency Medicine Southeastern Regional Meeting in Greenville, SC, February 21–22, 2020.
Identification
Copyright
© 2022 Published by Elsevier Inc.
