Pulmonary embolism: Accuracy and safety of a negative CT pulmonary angiogram and value of a negative D-dimer assay to exclude CT pulmonary angiogram-detectable pulmonary embolism

Authors: Subramaniam; Chou; Swarbrick; Karalus

Source: Australasian Radiology, Volume 50, Number 5, October 2006 , pp. 424-428(5)

Publisher: Blackwell Publishing

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Abstract:

Summary

This is a retrospective study to determine the accuracy and safety of a negative CT pulmonary angiogram (CTPA) based on clinical outcome and to determine the usefulness of a negative D-dimer assay before CTPA. A total of 483 patients with a negative CTPA study were followed up for 3 months, with the aim of detecting episodes of venous thromboembolism and mortality. Three hundred and forty-nine patients had an immunochromatographic D-dimer assay called `Simplify', carried out before a CTPA examination. Seventy-eight patients had a negative D-dimer assay and a negative CTPA. Three patients had a negative D-dimer assay and a positive CTPA. All three patients had a moderate pretest clinical probability. Of the 483 patients who had a negative CTPA and a 3-month follow up, 444 (92%) were alive and 39 (8%) had died. Of the 444 patients who were alive, none had any further suspected episode of thromboembolism or had received anticoagulation therapy within the follow-up period. Of those who died, none of the deaths was thought to be as a result of pulmonary embolism (PE). Single-detector helical CT can be used safely as the primary diagnostic test to evaluate PE. Negative Simplify D-dimer assay and low pretest clinical probability exclude CTPA-detectable PE, and a CTPA is unnecessary in this cohort of patients.

Keywords: computed tomography pulmonary angiogram; D-dimer; pulmonary embolism

Document Type: Research article

DOI: 10.1111/j.1440-1673.2006.01595.x

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