JRSM > Volume 98, Number 2 > Pp. 54-58

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Screening for pulmonary embolism with a D-dimer assay: do we still need to assess clinical probability as well?

Christopher J Hammond BM MRCS     Tajek B Hassan MD FFAEM  

Department of Accident and Emergency, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK

Correspondence to: C J HammondE-mail: doctorhammond{at}ntlworld.com

Clinical risk stratification and D-dimer assay can be of use in excluding pulmonary embolism in patients presenting to emergency departments but many D-dimer assays exist and their accuracy varies. We used clinical risk stratification combined with a quantitative latex-agglutination D-dimer assay to screen patients before arranging further imaging if required. Retrospective analysis of a sequential series of 376 patients revealed that no patient with a D-dimer of <275 ng/mL was diagnosed with pulmonary embolism, irrespective of clinical probability. We conclude that a latex-agglutination assay could be used to exclude pulmonary embolism without the necessity for clinical risk stratification. If these findings are borne out by further work, D-dimer strategies to exclude pulmonary embolism could substantially reduce imaging workload.

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