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Thromb Haemost 2001; 85(06): 995-998
DOI: 10.1055/s-0037-1615953
Review Article
Schattauer GmbH

Diagnostic Accuracy of Triage Tests to Exclude Pulmonary Embolism

Melvin R. Mac Gillavry
1   Department of Internal Medicine, Slotervaart Hospital, Academic Medical Center, Amsterdam, The Netherlands
,
Jeroen G. Lijmer
2   Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
,
Bernd-Jan Sanson
3   Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
,
Harry R. Büller
3   Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
,
Dees P. M. Brandjes
1   Department of Internal Medicine, Slotervaart Hospital, Academic Medical Center, Amsterdam, The Netherlands
3   Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
,
the ANTELOPE-Study Group › Author Affiliations
Further Information

Publication History

Received 16 August 2000

Accepted after resubmission 13 February 2001

Publication Date:
12 December 2017 (online)

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Summary

We performed a study in 403 prospectively included patients with suspected pulmonary embolism to compare the accuracy of a combination of the SimpliRED D-dimer assay and an intuitive clinical probability estimate with either one alone. Based on a conjoint diagnostic reference standard, including ventilation-perfusion lung scintigraphy and pulmonary angiography, the prevalence of pulmonary embolism was 31%. We demonstrated a high sensitivity (98%, 95% CI 95-100) and negative predictive value (94%, 95% CI 79-99) for the combination of the two tests. These figures were more favorable than for either test alone. The specificity of the combination was lower (11%, 95% CI 9-12) and consequently the proportion of patients in whom further diagnostic tests would have been avoided was only 8%. We conclude that the combined use of the SimpliRED test and the clinical probability estimate attains a higher sensitivity than either test alone. However, there remains a risk of false negatives and the exclusion efficiency is limited.

Key words

Pulmonary embolism - diagnosis - D-dimer - probability - estimate - triage

** The investigators who participated in this study are listed in the appendix. The Dutch Health Insurance Council (project # D094-90) provided financial support for this study. HRB is an established investigator of the Dutch Heart Foundation.


 

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