CTA联合D-DIMER在AAD中的诊断阈值.pdfVIP

American Journal of Emergency Medicine 31 (2013) 1047–1055 Contents lists available at SciVerse ScienceDirect American Journal of Emergency Medicine journal homepage: www. elsevi er. com/ locate/ ajem Original Contribution A decision analysis to determine a testing threshold for computed tomographic ☆,☆☆,★ angiography and D-dimer in the evaluation of aortic dissection R. Andrew Taylor MD a,⁎, Neel S. Iyer BA b a Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA b School of Public Health, Yale University, New Haven, CT, USA a r t i c l e i n f o a b s t r a c t Article history: Objective: The objective of this study is to determine at what probability of thoracic aortic dissection (TAD) to Received 10 March 2013 use a computed tomographic angiography (CTA) or a D-dimer test. Received in revised form 19 March 2013 Methods: We used decision analysis software to determine the testing threshold (TT) for 3 hypothetical Accepted 23 March 2013 decisions when evaluating for TAD: (1) no testing vs CTA, (2) no testing vs D-dimer, and (3) CTA vs D-dimer. One- and 2-way sensitivity analyses were performed to determine which variables were drivers of the TTs. Results: We found TTs of 0.03%, 0.013%, and 0.6% for decisions 1, 2, and 3, respectively. For all 3 decisions,