Clinical Case Database / Category: Patient Management

Pulmonary embolism: when D-dimer is not a useful test

Publication details

Dr David Salmon, Dr G Hamza
Foundation Years Journal, volume 9, issue 4, p.49 (123Doc Education, London, April 2015)

Abstract

D-dimer is a test commonly used to exclude pulmonary embolism (PE) due to its high negative predictive value. This case report describes a patient with new pulmonary embolism who was classified as 'moderate risk' according to the Well's score but had a negative d-dimer test. The diagnosis was confirmed with pulmonary angiography. This case effectively illustrates the rationale behind current guidelines on the diagnosis of pulmonary embolism. Guidelines state that a negative d-dimer test can exclude PE in 'low risk' patients according to the Well's score, whilst d-dimer is not useful in 'high risk' patients as a significant proportion will still have PE. However, in 'moderate risk' patients clinical usefulness of the d-dimer test depends on the sensitivity of the assay used. In this hospital we use only a moderately sensitive assay which is unable to exclude PE in this patient group.

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Authors

Dr David Salmon

Queen Elizabeth the Queen Mother Hospital
Margate, Kent, CT9 4AN
davidsalmon@doctors.net.uk

Dr G Hamza (Corresponding author)

Queen Elizabeth the Queen Mother Hospital
Margate, Kent, CT9 4AN
ghamza@doctors.org.uk

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