Article Text

other Versions

PDF
Comparison of D-dimer point of care test (POCT) against current laboratory test in patients with suspected venous thromboembolism (VTE) presenting to the emergency department (ED)
  1. Basav Sen1,
  2. Patrick Kesteven2,
  3. Peter Avery3
  1. 1Emergency Medicine, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  2. 2Department of Haematology, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  3. 3Department of Applied Statistics, Newcastle University, Newcastle upon Tyne, UK
  1. Correspondence to Dr Basav Sen Emergency Medicine, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK; bas.sen{at}nuth.nhs.uk

Abstract

Aims To compare quantitative point of care (POC) with laboratory d-dimer testing in patients with suspected venous thromboembolism (VTE) presenting to the emergency department.

Methods A prospective single centre diagnostic study in adults presenting with suspected VTE (pleuritic chest pain or leg swelling)

Results Main outcome measures were the statistical correlation of the two methods. Secondary outcome measures were: test turnaround times, correlation between D-dimer levels, Wells score and final diagnosis. The results showed that there was strong evidence of POC D-dimer being sufficiently accurate to be used as a screening device. The correlation between the two logged assay scores was good. Both logged scores correlated similarly with the Wells score. Once an equivalent cut-off value for POC D-dimer (412 ng/mL) was established, there were only 4 of 100 cases all of which were extremely close to the cut-off. D-dimer turnaround time decreased by 83%. A further recent analysis of laboratory times done in 2013 demonstrates that POC D-dimer results remain 62% quicker. Based on the D-dimer results 27 patients were scanned. The median Wells score in this group was 3.0 (range 2–10) median POC D-dimer levels of 2590 (412–5000) and median lab D-dimer levels of 864 (230–13 000) showing good correlation between D-dimer positive patients and the Wells score. Seven patients had positive scans. There was a significant difference in both logged D-dimer scores between the negative and positive groups indicating that raised D-dimer levels correlate well with final diagnosis.

Conclusions The POC device was comparable with the laboratory device and was sufficiently accurate to be used as a screening tool in the emergency department setting.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.