The diagnostic utility of D-dimer and other clinical variables in pregnant and post-partum patients with suspected acute pulmonary embolism

International Journal of Emergency Medicine

Hyun Choi¹  Dinesh Krishnamoorthy² 

[1] Emergency Department, University Hospital Lewisham;St George’s School of Medicine, University of London;

关键词: Pulmonary embolism;    Pregnancy;    Post-partum;    D-dimer;   

DOI  :  10.1186/s12245-018-0169-8

来源: DOAJ

【 摘 要 】

Abstract Background Pulmonary embolism (PE) during pregnancy remains one of the leading causes of maternal morbidity and mortality in the developed world. However, there is a paucity of high-quality evidence resulting in a lack of consensus in managing this group of patients. The aims of the study were to address the diagnostic utility of D-dimer for suspected PE in pregnant and post-partum patients and to identify any clinical presentation variables that are predictors of PE in this group of patients. Methods A retrospective case note review of 152 pregnant and post-partum patients who underwent diagnostic imaging (ventilation/perfusion (V/Q) or computed tomographic pulmonary angiography (CTPA)) for suspected PE at a tertiary teaching hospital from 2007 to 2011 was conducted. The reference range for D-dimer was less than 0.5 mg/L as being normal. The following variables were also assessed in terms of their predictive capability for PE diagnosis in pregnancy: heart rate (HR), mean arterial pressure (MAP), shock index (SI) and A-a gradient. Results The application of D-dimer testing for suspected PE in this study population had a sensitivity of 100% (95% CI, 73–100%), specificity of 42% (95% CI, 31–53%) and a likelihood negative ratio of 0. None of the clinical variables were significant predictors of PE according to regression analyses. Conclusions There is supportive evidence that a negative D-dimer result is useful as a means of ruling out PE in pregnant and post-partum patients. However, we need a larger prospective observational study to collaborate the findings.

【 授权许可】

Unknown