THE DIAGNOSIS OF PULMONARY EMBOLISM IN PATIENTS WITH NORMAL D-DIMER LEVELS

BILIR OZLEM¹, ERSUNAN GOKHAN¹, GIAKOUP BARIS², KALKAN ASIM¹, YAVASI OZCAN¹, KAYAYURT KAMIL¹

¹Assist Prof, Recep Tayyip Erdogan University Faculty of Medicine, Department of Emergency Medicine, Rize - ²Department of Emergency Medicine, Rize State Hospital, Rize, Turkey

Introduction: The combination of clinical probability assessment and the D-dimer test has been recommended to avoid unnecessary diagnostic testing in pulmonary thromboembolism (PTE). However, in clinical practice, patients are occasionally diagnosed with PTE despite normal D-dimer levels. In the present study, we reviewed the characteristics of cases in an emergency department (ED) in which a diagnosis of PTE was made despite normal D-dimer test results.

Materials and methods: The hospital records of 107 patients who were admitted to the ED of a teaching hospital and diagnosed with PTE between January 2011 and December 2013 were reviewed retrospectively. We acquired data for 11 patients (10.2%) in whom D-dimer measurements obtained by an automated latex turbidimetric quantitative method were below 500 ng/ml (0-450).

Results: Of the 11 patients, 72.7% (8/11) were female, and mean age was 71.5 ± 7.9 (61−84) years. The most common symptom was dyspnea (54.5%, n=6). The mean delay between onset of symptoms and admission to the ED was 10.6 (3-30) days, and follow-ups were performed for patients in other health facilities for various causes of dyspnea. When risk factors were analyzed with the Wells score, 18.2% (2/11) of patients had low probability of PTE, whereas 72.7% (8/11) had intermediate, and 9% (1/11) had high probability. According to the revised Geneva score, 18.2% (2/11) of patients were found to have low probability, and 81.8% (9/11) had intermediate probability. The Pulmonary Embolism Severity Index score classified 18.2% (2/11) of the patients in the low risk group, and the European Society of Cardiology classification classified 81.8% (9/11) in the low risk group.

Conclusion: In patients with nonspecific symptoms of PTE, the delay between onset of symptoms and admission to the ED is important. The risk factors of the patients and their pre-test probabilities should be considered along with D-dimer test results.