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Pre- and post-test probabilities of venous thromboembolism and diagnostic accuracy of D-dimer, estimated by European clinicians working in emergency departments

2017-11Journal article Restricted access
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dc.contributor.authorKristoffersen, Ann Helen
dc.contributor.authorAjzner, Eva
dc.contributor.authorBauça, Josep Miquel
dc.contributor.authorCarraro, Paolo
dc.contributor.authorFaria, Ana Paula
dc.contributor.authorHillarp, Andreas
dc.contributor.authorRogic, Dunja
dc.contributor.authorSozmen, Eser Y.
dc.contributor.authorWatine, Joseph
dc.contributor.authorMeijer, Piet
dc.contributor.authorSandberg, Sverre
dc.date.accessioned2018-03-01T18:50:10Z
dc.date.available2021-09-19T00:30:11Z
dc.date.issued2017-11
dc.descriptionLetter to the Editors-in-Chiefpt_PT
dc.description.abstractIntroduction: In patients with suspected venous thromboembolism (VTE), it is recommended to estimate the pre-test probability of VTE, either by experience or by standardized scoring schemes (e.g. Wells or Geneva score), before performing a D-dimer test. Patients with a low probability or unlikely VTE should have D-dimer performed, and if negative, VTE can be excluded, without further investigations, while if positive, the patient should be referred to radiologic imaging to confirm or exclude VTE. Patients with a high pre-test probability or likely VTE should be referred directly to radiologic imaging without D-dimer testing. Thus, to estimate the pre-test probability of VTE before D-dimer testing is of uttermost importance since the diagnostic algorithm and the interpretation of the D-dimer result is dependent upon this. Further, the diagnostic accuracy of D-dimer can be expressed by the likelihood ratio (LR). LR is the ratio between the probability of a test result given that VTE is present, and probability of the same test result if VTE is absent. A LR of< 1 decreases the probability of disease and a LR of> 1 increases the probability of disease. When clinicians estimate the pre-test probability for VTE, the post-test probability (after D-dimer testing) can be calculated using the LR for D-dimer either for a positive or negative test (i.e. D-dimer above or below the cut-off level, respectively). Probably, most clinicians do not know the LR for D-dimer, but it is indirectly implemented in the above mentioned algorithm for investigating a patient with suspected VTE. The advice to rule out VTE in a patient if the pre-test probability of VTE is low and the D-dimer is below the cut-off level reflects that the post-test probability of VTE in this case is sufficiently low to rule out VTE (should be< 1-2%). However, if the pre-test probability of VTE is high or likely, a negative D-dimer cannot decrease the post-test probability enough to rule out VTE (the post-test probability will still be about 10%) [4,5]. Therefore, only imaging should be requested when pre-test probability of VTE is high. A positive D-dimer cannot increase post-test probability of VTE enough to confirm VTE diagnosis in any case, since D-dimer is a non-specific VTE marker and levels can be increased in several other clinical situations (e.g. infection, inflammation, cancer and pregnancy). The aims of this survey were 1) to study the relationship between pre-test probabilities estimated by clinicians using two case histories and how the same clinicians' categorized the patients into low, moderate or high probability of VTE or into unlikely or likely VTE, and 2) to examine the clinicians' perception of diagnostic accuracy of D-dimer by calculating the LRs based upon their estimated pre- and post-test probabilities.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationThromb Res. 2017 Nov;159:19-23. doi:10.1016/j.thromres.2017.09.012. Epub 2017 Sep 18.pt_PT
dc.identifier.doi10.1016/j.thromres.2017.09.012pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.18/5117
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevier/European Thrombosis Research Organisation (ETROpt_PT
dc.relation.publisherversionhttp://dx.doi.org/10.1016/j.thromres.2017.09.012pt_PT
dc.subjectVenous Thromboembolismpt_PT
dc.subjectStandardized Scoring Schemespt_PT
dc.subjectD-dimerpt_PT
dc.subjectPre-test Probabilitypt_PT
dc.subjectPost-test Probabilitypt_PT
dc.subjectLikelihood Ratiopt_PT
dc.subjectDeep Venous Thrombosispt_PT
dc.subjectPulmonary Embolismpt_PT
dc.subjectAvaliação Externa da Qualidadept_PT
dc.subjectAEQpt_PT
dc.subjectPrograma Nacional de Avaliação Externa da Qualidadept_PT
dc.subjectPNAEQpt_PT
dc.titlePre- and post-test probabilities of venous thromboembolism and diagnostic accuracy of D-dimer, estimated by European clinicians working in emergency departmentspt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage23pt_PT
oaire.citation.startPage19pt_PT
oaire.citation.titleThrombosis Researchpt_PT
oaire.citation.volume159pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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