Clinical Case Database / Category: Patient Management
A case of D-Dimer negative pulmonary embolism
Dr Lawrence LM Li, Dr Brodie Paterson
Foundation Years Journal, volume 3, issue 10, p.41 (123Doc Education, London, December 2009)
Pulmonary embolism (PE) presents a diagnostic challenge for the emergency physician. Undiagnosed PE is associated with a mortality of up to 30% although more recent data suggests a lower mortality rate (1). The advent of D-dimer testing looked to bring a sensitive â€œrule-outâ€ test to EM. Reviews have shown the D-dimer testing is only accurate in the low-risk group (2). This article highlights a case of a patient who despite having clinical signs of a pulmonary embolism had their diagnosis delayed due to a negative D-dimer result.
In conclusion it should be remembered that D-dimers are not sensitive enough to rule out PE in patients at high risk. Although the use of D-dimers initially promised to be very useful in ruling out PE subsequent reviews have suggested it is only accurate in low-risk patients.
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Dr Lawrence LM Li
Department of Accident and Emergency
Dr Brodie Paterson
Department of Accident and Emergency
2. British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group (2003) British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax,58: 470â484.
5. Wells PS, Anderson DR, Roger MA, et al. (2001) Excluding pulmonary embolism at the bedside without diagnostic imaging: Management of patients with suspected pulmonary embolism presenting to the Emergency Department by using a simple clinical model and D-dimer. Annals of Internal Medicine, 135: 98â107.
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About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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