New analysis evaluates ruling out pulmonary embolism in high-risk patients based on D-dimer levels

Des Plaines, IL — A new study investigating D-dimer testing in patients who are at higher risk of pulmonary embolism (PE) has been published in the February issue of Academic Emergency Medicine (AEM), the peer-reviewed journal of the Society for Academic Emergency Medicine (SAEM).

The study, titled Failure rate of D-dimer testing in patients with high clinical probability of pulmonary embolism: Ancillary analysis of three European studies, evaluates the safety of ruling out PE based on D-dimer testing among patients who present a high clinical probability of the condition.

Pulmonary embolism is commonly suspected in emergency departments (EDs) and is a potentially life-threatening condition. Accurate diagnosis is critical for ensuring effective management and treatment. For patients who are at a low or moderate risk for PE, a diagnostic strategy based on D-dimer levels is advised due to its high negative predictive value. In patients with a high clinical probability of PE, the high prevalence may reduce the negative predictive value of D-dimer testing and increase the risk of diagnostic failure. Therefore, guidelines recommend that these high-risk patients undergo chest imaging (CI) without D-dimer testing, although very little evidence supports this approach.

The study aims to address the uncertainty surrounding the safety of excluding PE based on D-dimer levels in high-risk patients. Lead author Héloïse Bannelier, MD, and colleagues conducted a post hoc analysis of three European studies (PROPER, MODIGLIANI, and TRYSPEED). Patients included in the analysis had a high clinical probability of PE, according to either the Wells or the revised Geneva score, and had undergone D-dimer testing.

The findings indicated that ruling out PE based on a D-dimer level below the age-adjusted threshold was safe, with no missed cases of pulmonary embolism. However, the study's sample size was not large enough to draw a definitive conclusion on the safety of this diagnostic strategy. The results of this study may have important implications for the clinical management of high-risk PE patients. Further research is necessary to validate these findings in larger populations.

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ABOUT ACADEMIC EMERGENCY MEDICINE

Academic Emergency Medicine, the monthly journal of Society for Academic Emergency Medicine, features the best in peer-reviewed, cutting-edge original research relevant to the practice and investigation of emergency care. The above study is published open access and can be downloaded by following https://doi.org/10.1111/acem.15032. Journalists wishing to interview the authors may contact Melissa Matusek at mmatusek@saem.org.

ABOUT THE SOCIETY FOR ACADEMIC EMERGENCY MEDICINE

SAEM is a 501(c)(3) not-for-profit organization dedicated to the improvement of care of the acutely ill and injured patient by leading the advancement of academic emergency medicine through education and research, advocacy, and professional development. To learn more, visit saem.org.