Abstract
D-DIMER AND EXCLUSION OF PULMONARY EMBOLISM
BACKGROUND: Pulmonary embolism (PE) is a common and potentially severe disease and the diagnosis is a difficult challenge. D-dimers are degradation products of cross-linked fibrin that are found circulating in the bloodstream after endogenous fibrinolysis of blood clots. The ability of various D-dimer assays to exclude the diagnosis of PE is controversial. A specific monoclonal antibody based ELISA assay has been found to have a high negative predictive value, but it is time consuming and requires testing in series. Many Norwegian hospitals use the STALiatest, a rapid, quantitative and automated micro latex immunoassay method.
The aim of this literature study was to determine this assay s ability to exclude PE in the emergency department.
MATERIAL AND METHODS: Published papers in English were identified by searching Pubmed for liatest and pulmonary embolism . The methods and results of the studies included are presented in two tables based on the STARD checklist for evaluating an article.
RESULTS: Eight English articles were identified, of which six of relevance were included in this study. They showed sensitivities between 90-100% and negative predictive value between 90-100% for STALiatest and PE.
INTERPRETATION: Five of the six articles were of good quality. Negative predictive value varied according to pretestprobability. STALiatest is not suitable to exclude PE in patients with high pretestprobability. The Clinician must know that although STALiatest has a high sensitivity and negative predictive value, false negative tests will occur.