Inappropriate use of d-dimer assay and pulmonary ct angiography in the evaluation of suspected acute pulmonary embolism

Fang Yin, Thomas Wilson, Albert Della Fave, Moira Larsen, Jenni Yoon, Binyam Nugusie, Howard Freeland, Robert Dobbin Chow

Research output: Contribution to journalArticlepeer-review

Abstract

The authors question whether the d-dimer assay and pulmonary computed tomography angiography (CTA) are being used appropriately to evaluate suspected acute pulmonary embolism (PE) at their hospital. To answer this question, a retrospective review was performed on all emergency department (ED) patients who underwent d-dimer assay and/or CTA from August 15, 2008, to August 14, 2009. The authors' algorithm for diagnosing PE requires that patients with low or intermediate probability of acute PE undergo a d-dimer assay, followed by CTA if the d-dimer is positive. Patients with high probability of PE should have CTA performed without a d-dimer assay. This result suggests that d-dimer assay and CTA are used inappropriately to evaluate patients with suspected acute PE in our ED. The low threshold for initiating an evaluation for PE decreases the prevalence of PE in this population.

Original languageEnglish (US)
Pages (from-to)74-79
Number of pages6
JournalAmerican Journal of Medical Quality
Volume27
Issue number1
DOIs
StatePublished - Jan 2012

Keywords

  • CT angiography
  • D-dimer
  • emergency department
  • pulmonary embolism

ASJC Scopus subject areas

  • Health Policy

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