Original Articles
Usefulness of Fast ELISA Determination of D-Dimer Levels for Diagnosing Pulmonary Embolism in an Emergency Room
A. Friera-Reyesa,
, P. Caballeroa, N. Ruiz-Giménezb, P. Artiedac, L. Domínguezd, E. Pérez-Amore, C. Suárezb, for the Venous Thromboembolic Disease Working Group
Corresponding author
alfita1@telefonica.net
Correspondence: Dr. A. Friera-Reyes. Servicio de Radiodiagnóstico. Hospital de la Princesa. Diego de León, 62. 28006 Madrid. España
Correspondence: Dr. A. Friera-Reyes. Servicio de Radiodiagnóstico. Hospital de la Princesa. Diego de León, 62. 28006 Madrid. España
a Servicio de Radiodiagnóstico, Hospital de la Princesa, Madrid, Spain
b Servicio de Medicina Interna, Hospital de la Princesa, Madrid, Spain
c Servicio de Análisis Clínico, Hospital de la Princesa, Madrid, Spain
d Servicio de Medicina Nuclear, Hospital de la Princesa, Madrid, Spain
e Servicio de Neumología, Hospital de la Princesa, Madrid, Spain
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Friera-Reyes. Servicio de Radiodiagnóstico. Hospital de la Princesa. Diego de León, 62. 28006 Madrid. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2004-09-20" "fechaAceptado" => "2005-01-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key Words" "identificador" => "xpalclavsec154154" "palabras" => array:3 [ 0 => "Pulmonary embolism" 1 => "Thromboembolic disease" 2 => "D-dimer" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154153" "palabras" => array:3 [ 0 => "Embolia pulmonar" 1 => "Enfermedad tromboembólica" 2 => "Dímero-D" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">To determine the sensitivity and negative predictive value of D-dimer levels measured by fast enzyme-linked immunoabsorbent assay (ELISA) in pulmonary embolism.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">Prospective study of consecutive patients with suspicion of pulmonary embolism attended in the Emergency Room of the Hospital de la Princesa in Madrid, Spain. Thromboembolism was diagnosed with an algorithm established in the hospital, and D-dimer levels were determined by fast ELISA (VIDAS D-dimer Assay) in each patient suspected of pulmonary embolism. Patients with negative findings from a test not considered a reference method for thromboembolism were followed for 3 months.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Of 132 patients with clinical suspicion, 28 (21.2%) were positive and 104 (78.7%) were negative for embolism. D-dimer levels were below 0.5 μg/mL in 31 patients, 30 of whom did not have pulmonary thromboembolism whereas 1 did. D-dimer levels were abowe 0.5 μg/mL in 101 patients; thromboembolism did not occur in 74 of these but was reported in the remaining 27. For a value of 1 μg/mL, 66 patients had values below the cut off, 3 of whom presented pulmonary embolism. The remaining 66 patients had D-dimer levels above or equal to 1 μg/mL; 25 of them had a positive diagnosis for embolism and 41 had a negative diagnosis. Sensitivity and negative predictive values were 96.4% (95% confidence interval [CI], 79.8%-99.9%) and 96.8% (95% CI, 81.5%-98.8%), respectively, at a cut off of 0.5 μg/mL; and 89.2% (95% CI, 70.6%-97.2%) and 95.45% (95% CI, 86.4%-98.8 %), respectively, at a cut off of 1 μg/mL.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">In an emergency room, thromboembolism can be excluded if plasma levels of D-dimer measured by fast ELISA are below 0.5 μg/mL because of the high negative predictive value at this cut off.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Determinar la sensibilidad y el valor predictivo negativo del dímero-D, por enzimoinmunoanálisis (ELISA) rápido, en la embolia pulmonar.</p> <span class="elsevierStyleSectionTitle">Pacientes y méatodos</span><p class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo de pacientes atendidos consecutivamente por sospecha clínica de embolia en el Servicio de Urgencias del Hospital de la Princesa de Madrid. El diagnóstico de tromboembolia se basó en el algoritmo establecido en el hospital, y se determinó el dímero-D por ELISA (VIDAS) en cada paciente con sospecha de embolia pulmonar. A los pacientes con resultado negativo para tromboembolia, establecido por una prueba no considerada de referencia, se les realizó seguimiento clínico a los 3 meses.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">De 132 pacientes con sospecha clínica, 28 (21,2%) fueron positivos y 104 (78,7%) negativos para embolia. El dímero-D fue < a 0,5 μg/ml en 31 pacientes, de los que 30 no tuvieron tromboembolia pulmonar y 1 sí la tuvo. De los 101 pacientes con dímero-D > 0,5 μg/ml, en 74 no se produjo tromboembolia y en 27 sí.</p><p class="elsevierStyleSimplePara elsevierViewall">Si se considera como punto de corte 1 μg/ml, hubo 66 pacientes con valores inferiores, de los que 3 presentaron embolia pulmonar. Otros 66 pacientes mostraron un dímero-D ≤ 1 μg/ml; de ellos, 25 tuvieron un diagnóstico positivo para embolia y 41 negativo. La sensibilidad y el valor predictivo negativo para 0,5 μg/ml fue de 96,4 (intervalo de confianza [IC] del 95%, 79,8-99,9) y 96,8 (IC del 95%, 81,5-98,8), respectivamente; para 1 μg/ml fue de 89,2 (IC del 95%, 70,6-97,2) y 95,45 (IC del 95%, 86,4-98,8), respectivamente.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Los valores de dímero-D plasmático, determinados por la técnica de ELISA rápido (VIDAS), < 0,5 μg/ml permiten excluir con alto valor predictivo negativo una tromboembolia pulmonar en un servicio de urgencias.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis of pulmonary embolism: have we reached our goal?" 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 4 | 9 |
| 2024 October | 29 | 19 | 48 |
| 2024 September | 33 | 13 | 46 |
| 2024 August | 65 | 45 | 110 |
| 2024 July | 35 | 23 | 58 |
| 2024 June | 33 | 19 | 52 |
| 2024 May | 45 | 24 | 69 |
| 2024 April | 21 | 22 | 43 |
| 2024 March | 22 | 13 | 35 |
| 2024 February | 23 | 23 | 46 |
| 2023 March | 1 | 6 | 7 |
| 2023 February | 26 | 20 | 46 |
| 2023 January | 17 | 27 | 44 |
| 2022 December | 24 | 26 | 50 |
| 2022 November | 32 | 22 | 54 |
| 2022 October | 21 | 39 | 60 |
| 2022 September | 24 | 27 | 51 |
| 2022 August | 24 | 47 | 71 |
| 2022 July | 18 | 40 | 58 |
| 2022 June | 20 | 28 | 48 |
| 2022 May | 19 | 33 | 52 |
| 2022 April | 18 | 43 | 61 |
| 2022 March | 29 | 44 | 73 |
| 2022 February | 17 | 25 | 42 |
| 2022 January | 15 | 41 | 56 |
| 2021 December | 16 | 43 | 59 |
| 2021 November | 22 | 57 | 79 |
| 2021 October | 24 | 57 | 81 |
| 2021 September | 16 | 41 | 57 |
| 2021 August | 13 | 32 | 45 |
| 2021 July | 16 | 30 | 46 |
| 2021 June | 21 | 31 | 52 |
| 2021 May | 11 | 25 | 36 |
| 2021 April | 31 | 44 | 75 |
| 2021 March | 18 | 11 | 29 |
| 2021 February | 11 | 25 | 36 |
| 2021 January | 16 | 20 | 36 |
| 2020 December | 10 | 10 | 20 |
| 2020 November | 7 | 11 | 18 |
| 2020 October | 10 | 4 | 14 |
| 2020 September | 3 | 6 | 9 |
| 2020 August | 10 | 14 | 24 |
| 2020 July | 14 | 16 | 30 |
| 2020 June | 4 | 7 | 11 |
| 2020 May | 9 | 12 | 21 |
| 2020 April | 13 | 16 | 29 |
| 2020 March | 7 | 14 | 21 |
| 2020 February | 9 | 20 | 29 |
| 2020 January | 22 | 18 | 40 |
| 2019 December | 16 | 13 | 29 |
| 2019 November | 9 | 15 | 24 |
| 2019 October | 12 | 11 | 23 |
| 2019 September | 9 | 10 | 19 |
| 2019 August | 10 | 13 | 23 |
| 2019 July | 15 | 14 | 29 |
| 2019 June | 6 | 6 | 12 |
| 2019 May | 13 | 13 | 26 |
| 2019 April | 61 | 11 | 72 |
| 2019 March | 15 | 24 | 39 |
| 2019 February | 9 | 10 | 19 |
| 2019 January | 11 | 18 | 29 |
| 2018 December | 6 | 19 | 25 |
| 2018 November | 25 | 9 | 34 |
| 2018 October | 35 | 9 | 44 |
| 2018 September | 15 | 12 | 27 |
| 2018 May | 8 | 0 | 8 |
| 2018 April | 20 | 7 | 27 |
| 2018 March | 2 | 3 | 5 |
| 2018 February | 8 | 10 | 18 |
| 2018 January | 9 | 7 | 16 |
| 2017 December | 3 | 8 | 11 |
| 2017 November | 4 | 2 | 6 |
| 2017 October | 4 | 9 | 13 |
| 2017 September | 5 | 16 | 21 |
| 2017 August | 10 | 12 | 22 |
| 2017 July | 4 | 7 | 11 |
| 2017 June | 10 | 21 | 31 |
| 2017 May | 6 | 14 | 20 |
| 2017 April | 3 | 6 | 9 |
| 2017 March | 5 | 7 | 12 |
| 2017 February | 3 | 3 | 6 |
| 2017 January | 4 | 4 | 8 |
| 2016 December | 3 | 12 | 15 |
| 2016 November | 5 | 6 | 11 |
| 2016 October | 13 | 8 | 21 |
| 2016 September | 16 | 10 | 26 |
| 2016 August | 6 | 2 | 8 |
| 2016 July | 2 | 0 | 2 |
| 2016 May | 1 | 0 | 1 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 110 | 10 | 120 |
| 2015 September | 128 | 15 | 143 |
| 2015 August | 91 | 10 | 101 |
| 2015 July | 93 | 13 | 106 |
| 2015 June | 46 | 5 | 51 |
| 2015 May | 56 | 13 | 69 |
| 2015 April | 57 | 8 | 65 |
| 2015 March | 58 | 7 | 65 |
| 2015 February | 60 | 3 | 63 |
| 2015 January | 55 | 5 | 60 |
| 2014 December | 51 | 3 | 54 |
| 2014 November | 53 | 8 | 61 |
| 2014 October | 91 | 7 | 98 |
| 2014 September | 68 | 8 | 76 |
| 2014 August | 66 | 13 | 79 |
| 2014 July | 65 | 9 | 74 |
| 2014 June | 74 | 8 | 82 |
| 2014 May | 84 | 16 | 100 |
| 2014 April | 80 | 5 | 85 |
| 2014 March | 93 | 14 | 107 |
| 2014 February | 86 | 9 | 95 |
| 2014 January | 80 | 10 | 90 |
| 2013 December | 67 | 13 | 80 |
| 2013 November | 54 | 8 | 62 |
| 2013 October | 73 | 10 | 83 |
| 2013 September | 65 | 9 | 74 |
| 2013 August | 67 | 11 | 78 |
| 2013 July | 54 | 14 | 68 |
| 2013 June | 45 | 9 | 54 |
| 2013 May | 50 | 4 | 54 |
| 2013 April | 28 | 7 | 35 |
| 2013 March | 8 | 2 | 10 |
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