Diagnostic utility of D-dimer measurement in patients with clinical suspect of pulmonary thromboembolism in the setting of an Internal Medicine Department

The diagnosis of pulmonary thromboembolism (PTE) may be a challenge in many cases, particularly among the elderly patients. To establish the diagnostic utility of D-dimer measurement by a rapid semi-quantitative immunoassay (NycoCard, D-Dimer, normal value < or =0.3 mg/l) in a series of patients with suspected PTE admitted to an Internal Medicine Department. Retrospective review of 48 patients admitted to our Department with the clinical suspect of PTE and D-dimer assay, in whom a lung ventilation/perfusion scan was conclusive (high or normal/very low/low probability of PTE). The median age of patients was 67.4 years and 79.2% were older than 60 years. For the diagnosis of PTE, the values of sensitivity, specificity, positive predictive value, and negative predictive value were 95.2%, 55.5%, 62.5% and 93.7%, respectively. When patients with potential confounding factors in the measurement of D-dimer (surgery and/or trauma in the 2 previous weeks, or neoplasm) were excluded, similar results were obtained. When a normal D-dimer (< or =0.3 mg/l) measurement by a rapid semi-quantitative immunoassay (NycoCard) is obtained, the presence of PTE is very unlikely. An increased D-dimer should lead to additional complementary tests to confirm or rule out PTE. These results apply for patients aged over 60 years and are not influenced by potential confounding factors.