Is D-dimer used according to clinical algorithms in the diagnostic work-up of patients with suspicion of venous thromboembolism? A study in six European countries. Issue 142 (June 2016)

• Record Type: Journal Article
• Authors: Kristoffersen, Ann Helen; Ajzner, Eva; Rogic, Dunja; Sozmen, Eser Y.; Carraro, Paolo; Faria, Ana Paula; Watine, Joseph; Meijer, Piet; Sandberg, Sverre
• Is Part Of: Thrombosis research. Issue 142(2016)
• Page Start: 1
• Page End: 7
• Publication Date: 2016-06
• Subjects: VTE venous thromboembolism -- DVT deep venous thrombosis -- PE pulmonary embolism -- CTPA computer tomography pulmonary angiography; Venous thromboembolism -- Clinical decision rules -- D-dimer -- Pre-test probability -- Clinical algorithms; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2016.04.001
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Introduction: Clinical algorithms consisting of pre-test probability estimation and D-dimer testing are recommended in diagnostic work-up for suspected venous thromboembolism (VTE). The aim of this study was to explore how physicians working in emergency departments investigated patients suspected to have VTE. Materials and methods: A questionnaire with two case histories related to the diagnosis of suspected pulmonary embolism (PE) (Case A) and deep venous thrombosis (DVT) (Case B) were sent to physicians in six European countries. The physicians were asked to estimate pre-test probability of VTE, and indicate their clinical actions. Results: In total, 487 physicians were included. Sixty percent assessed pre-test probability of PE to be high in Case A, but 7% would still request only D-dimer and 11% would exclude PE if D-dimer was negative, which could be hazardous. Besides imaging, a D-dimer test was requested by 41%, which is a "waste of resources" (extra costs and efforts, no clinical benefit). For Case B, 92% assessed pre-test probability of DVT to be low. Correctly, only D-dimer was requested by 66% of the physicians, while 26% requested imaging, alone or in addition to D-dimer, which is a "waste of resources". Conclusions: These results should encourage scientific societies to improve the dissemination and knowledge of the current recommendations for the diagnosis of VTE. Highlights: Majority of the physicians estimated pre-test probability by clinical decision scores. Standardised clinical algorithms were often not followed. Both D-dimer and imaging were regularly requested initially. Results indicated waste of resources and potential hazardous actions.