TY - JOUR
T1 - Does an immunochromatographic D-dimer exclude acute lower limb deep venous thrombosis?
AU - Subramaniam, Rathan M.
AU - Heath, Rebekah
AU - Cox, Kim
AU - Chou, Tina
AU - Stewart, Joanna
AU - Sleigh, Jamie
PY - 2006/10
Y1 - 2006/10
N2 - Background: A pre-test probability score and D-dimer may reduce the need for ultrasound examinations for excluding lower limb deep venous thrombosis (DVT). Objective: To establish the accuracy of an immunochromatographic D-dimer assay called 'Simplify' for diagnosis of acute DVT by complete (calf veins included) lower limb ultrasound examination. Methods: A total of 453 consecutive patients presented to the ED of a tertiary centre with suspected first episode of DVT, were prospectively recruited. A pre-test probability score (Hamilton Score), an immunochromatographic D-dimer and a complete, single, unilateral lower limb ultrasound examination were performed in all patients. All patients with a negative ultrasound examination were followed up for 3 months. Results: There were 159 men and 294 women with a mean age of 55.8 years (SD 20.3). Of the 227 patients with a negative D-dimer, 214 patients had negative ultrasound examinations and 13 patients had isolated calf DVT. Among the 226 patients with a positive D-dimer, 74 patients had DVT and 152 patients had negative ultrasound examinations. The sensitivity, specificity, positive and negative predictive values were 85.1% (75.8-91.8), 58.5% (53.4-63.5), 32.7% (26.6-38.9) and 94.3% (90.4-96.9), respectively. One hundred and sixty-five patients had an unlikely Hamilton Score and a negative D-dimer. The negative predictive value of the immunochromatographic D-dimer in an unlikely Hamilton Score population was 98.8% (95.7-99.8%). Conclusion: An unlikely probability Hamilton Score and a negative immunochromatographic D-dimer reliably exclude both proximal and isolated calf DVT.
AB - Background: A pre-test probability score and D-dimer may reduce the need for ultrasound examinations for excluding lower limb deep venous thrombosis (DVT). Objective: To establish the accuracy of an immunochromatographic D-dimer assay called 'Simplify' for diagnosis of acute DVT by complete (calf veins included) lower limb ultrasound examination. Methods: A total of 453 consecutive patients presented to the ED of a tertiary centre with suspected first episode of DVT, were prospectively recruited. A pre-test probability score (Hamilton Score), an immunochromatographic D-dimer and a complete, single, unilateral lower limb ultrasound examination were performed in all patients. All patients with a negative ultrasound examination were followed up for 3 months. Results: There were 159 men and 294 women with a mean age of 55.8 years (SD 20.3). Of the 227 patients with a negative D-dimer, 214 patients had negative ultrasound examinations and 13 patients had isolated calf DVT. Among the 226 patients with a positive D-dimer, 74 patients had DVT and 152 patients had negative ultrasound examinations. The sensitivity, specificity, positive and negative predictive values were 85.1% (75.8-91.8), 58.5% (53.4-63.5), 32.7% (26.6-38.9) and 94.3% (90.4-96.9), respectively. One hundred and sixty-five patients had an unlikely Hamilton Score and a negative D-dimer. The negative predictive value of the immunochromatographic D-dimer in an unlikely Hamilton Score population was 98.8% (95.7-99.8%). Conclusion: An unlikely probability Hamilton Score and a negative immunochromatographic D-dimer reliably exclude both proximal and isolated calf DVT.
KW - D-dimer
KW - Deep venous thrombosis
KW - Ultrasound
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U2 - 10.1111/j.1742-6723.2006.00866.x
DO - 10.1111/j.1742-6723.2006.00866.x
M3 - Article
C2 - 17083634
AN - SCOPUS:33750435178
SN - 1742-6731
VL - 18
SP - 457
EP - 463
JO - EMA - Emergency Medicine Australasia
JF - EMA - Emergency Medicine Australasia
IS - 5-6
ER -