shifting up cutoff value of d-dimer in the evaluation of pulmonary embolism a viable option possible risks and benefits改变了截断值评价肺栓塞肺动脉栓塞的一个可行的选择可能的风险和好处.pdfVIP

Hindawi Publishing Corporation Emergency Medicine International Volume 2012, Article ID 517375, 6 pages doi:10.1155/2012/517375 Clinical Study Shifting Up Cutoff Value of D-Dimer in the Evaluation of Pulmonary Embolism: A Viable Option? Possible Risks and Benefits Bennidor Raviv and Shlomo H. Israelit Department of Emergency Medicine, Rambam Health Care Campus, Haifa 31096, Israel Correspondence should be addressed to Bennidor Raviv, b raviv@.il Received 5 April 2012; Revised 21 May 2012; Accepted 4 June 2012 Academic Editor: Chak W. Kam Copyright © 2012 B. Raviv and S. H. Israelit. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. To evaluate the viability of the possibility to use a higher D-dimer value than the one used today in the clinical algorithms evaluating patients suspected to have pulmonary embolism. Methods. A retrospective analysis of 300 serial patients for whom D- dimer values were taken during a 10 month period in the emergency room of a tertiary medical center. Results. Our analysis showed that it may be safe and cost effective to use a D-dimer value of 900 ng/ml rather than the value of 500 ng/ml accepted today, with sensitivity of 94.4%. In younger patients [under 40 years] the sensitivity reached was even higher—100%. Conclusions. Raising cutoff values of D-dimer in screening for pulmonary embolism seems a viable option. There may be a place for “tailoring” cutoff values according individual patient characteristics, such as according age groups. More studies of the subject are warranted. 1. Introduction It is a nonspecific