Failure rate of D-dimer testing in patients with high clinical probability of pulmonary embolism: Ancillary analysis of three European studies
| dc.rights.license | open | en_US |
| dc.contributor.author | BANNELIER, Heloise | |
| dc.contributor.author | KAPFER, Thomas | |
| dc.contributor.author | ROUSSEL, Melanie | |
| dc.contributor.author | FREUND, Yonathan | |
| dc.contributor.author | ALAME, Karine | |
| hal.structure.identifier | Bordeaux population health [BPH] | |
| dc.contributor.author | CATOIRE, Pierre | |
| dc.contributor.author | VROMANT, Amelie | |
| dc.date.accessioned | 2025-05-07T12:52:06Z | |
| dc.date.available | 2025-05-07T12:52:06Z | |
| dc.date.issued | 2025-02-01 | |
| dc.identifier.issn | 1553-2712 | en_US |
| dc.identifier.uri | https://oskar-bordeaux.fr/handle/20.500.12278/206575 | |
| dc.description.abstractEn | Background: In patients with a high clinical probability of pulmonary embolism (PE), the high prevalence can lower the D-dimer negative predictive value and increase the risk of diagnostic failure. It is therefore recommended that these high-risk patients should undergo chest imaging without D-dimer testing although no evidence supports this recommendation. Objective: The objective was to evaluate the safety of ruling out PE based on D-dimer testing among patients with a high clinical probability of PE. Methods: This was a post hoc analysis of three European studies (PROPER, MODIGLIANI, and TRYSPEED). Patients were included if they presented a high clinical probability of PE (according to either the Wells or the revised Geneva score) and underwent D-dimer testing. The D-dimer–based strategy ruled out PE if the D-dimer level was below the age-adjusted threshold (i.e., <500 ng/mL in patients aged less than 50 and age × 10 ng/mL in patients older than 50). The primary endpoint was a thromboembolic event in patients with negative D-dimer either at index visit or at 3-month follow-up. A Bayesian approach estimated the probability that the failure rate of the D-dimer–based strategy was below 2% given observed data. Results: Among the 12,300 patients included in the PROPER, MODIGLIANI, and TRYSPEED studies, 651 patients (median age 68 years, 60% female) had D-dimer testing and a high clinical probability of PE and were included in the study. PE prevalence was 31.3%. Seventy patients had D-dimer levels under the age-adjusted threshold, and none of them had a PE after follow-up (failure rate 0.0% [95% CI 0.0%–6.5%]). Bayesian analysis reported a credible interval of 0.0%–4.1%, with a 76.2% posterior probability of a failure rate below 2%. Conclusions: In this study, ruling out PE in high-risk patients based on D-dimer below the age-adjusted threshold was safe, with no missed PE. However, the large CI of the primary endpoint precludes a definitive conclusion. © 2024 The Author(s). Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine. | |
| dc.language.iso | EN | en_US |
| dc.rights | Attribution-NonCommercial-NoDerivs 3.0 United States | * |
| dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/3.0/us/ | * |
| dc.subject.en | Bayesian Analysis | |
| dc.subject.en | D‐Dimer | |
| dc.subject.en | Wells | |
| dc.subject.en | Computed Tomography Pulmonary Angiography | |
| dc.subject.en | Emergency Department | |
| dc.subject.en | Emergency Medicine | |
| dc.subject.en | Probability Scores | |
| dc.subject.en | Pulmonary Embolism | |
| dc.subject.en | Revised Geneva | |
| dc.title.en | Failure rate of D-dimer testing in patients with high clinical probability of pulmonary embolism: Ancillary analysis of three European studies | |
| dc.title.alternative | Acad Emerg Med | en_US |
| dc.type | Article de revue | en_US |
| dc.identifier.doi | 10.1111/acem.15032 | en_US |
| dc.subject.hal | Sciences du Vivant [q-bio]/Santé publique et épidémiologie | en_US |
| dc.identifier.pubmed | 39487597 | en_US |
| bordeaux.journal | Academic Emergency Medicine | en_US |
| bordeaux.page | 116-122 | en_US |
| bordeaux.volume | 32 | en_US |
| bordeaux.hal.laboratories | Bordeaux Population Health Research Center (BPH) - UMR 1219 | en_US |
| bordeaux.issue | 2 | en_US |
| bordeaux.institution | Université de Bordeaux | en_US |
| bordeaux.institution | INSERM | en_US |
| bordeaux.team | BIOSTAT_BPH | en_US |
| bordeaux.peerReviewed | oui | en_US |
| bordeaux.inpress | non | en_US |
| hal.identifier | hal-05059728 | |
| hal.version | 1 | |
| hal.date.transferred | 2025-05-07T12:52:09Z | |
| hal.popular | non | en_US |
| hal.audience | Internationale | en_US |
| hal.export | true | |
| dc.rights.cc | Pas de Licence CC | en_US |
| bordeaux.COinS | ctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=Academic%20Emergency%20Medicine&rft.date=2025-02-01&rft.volume=32&rft.issue=2&rft.spage=116-122&rft.epage=116-122&rft.eissn=1553-2712&rft.issn=1553-2712&rft.au=BANNELIER,%20Heloise&KAPFER,%20Thomas&ROUSSEL,%20Melanie&FREUND,%20Yonathan&ALAME,%20Karine&rft.genre=article |