Pulmonary embolism diagnosis with D-dimer levels and computed tomography

Abstract

Background: Pulmonary embolism (PE), a common heart and blood vessel disease, causes complications such as haemodynamic instability and cardiovascular mortality. Timely diagnosis and treatment are imperative for managing this potentially life-threatening condition.

Aim: The aim of this study was to establish the relationship between an elevated D-dimer level and a positive computed tomography pulmonary angiogram (CTPA), which could confirm PE in patients with chest pain and suspected PE.

Setting: Data were collected at a private diagnostic radiology practice located in Bloemfontein, South Africa.

Methods: Data were retrospectively collected from the Picture Archiving and Communications System (PACS).

Results: Of the sampled patients (n = 1219), only 16.7% were diagnosed with PE after CTPA. Approximately 14% of the D-dimer-positive patient group were diagnosed with PE and, in the D-dimer-negative patient group, approximately 20% of the patients were diagnosed with PE. Of the patients sampled, 86% were not diagnosed with PE despite having increased D-dimer values. No specific trends in the relation between elevated D-dimer levels and a positive PE diagnosis could be identified at the significance level of 0.05; a Chi-square test of independence indicated (χ² [1, N = 995] = 1.84, p = 0.175).

Conclusion: No strong relationship between elevated D-dimer levels in the blood and a positive yield of PE after CTPA; was found hence, clinical decision rules for PE workups need refining, especially to limit unnecessary CTPA referrals in this setting.

Contribution: The findings suggest that PE workup at the private practice should be revised to improve the quality of service.