Role of D-dimer detection in screening of pulmonary embolism in patients presenting in emergency depantment setting

Objective The aim of this study is to evaluate the role of D-dimer detection in screening of pulmonary embolism (PE) in emergency room. Methods Plasma D-dimer was detected in patients with preliminary assessment of PE according to the clinical manifestation from June 2001 to June 2003. Lung scan and/or high resolution helix pulmonary CT were performed in all the patients, pulmonary angiography were performed in suitable patients to confirm the diagnosis of PE.Results All the 105 patients included, 51 patients had a plasma D-dimer level of higher than 500μg/L. In the patients with higher plasma level of D-dimer, 37 patients were diagnosed as PE, PE was ruled out in 9 patients, 5 patients with high level of D-dimer were highly suspicious of PE, yet evidences for diagnosis of PE were not enough. Of the 54 patients with lower level of D-dimer (500 μg/L), PE was ruled out in 53 patients, only one patient was diagnosed as PE. Of the 38 patients diagnosed as PE, 34 got good outcome after appropriate treatment, yet 4 patients died, thus the mortality rate 10.5%. The positive predictive value of the detection of D-dimer was 72.5%(37/51),the negative predictive value 98.1%(53/54)。Conclusions D-dimer is an important parameter in the screening of PE diagnosis in emergency room.