Evidence map›Paper›PMID 33468044›Full record

Observational studyBMC emergency medicine2021

Utilization of serum D-dimer assays prior to computed tomography pulmonary angiography scans in the diagnosis of pulmonary embolism among emergency department physicians: a retrospective observational study.

Leila Salehi, Prashant Phalpher, Hubert Yu, Jeffrey Jaskolka, Marc Ossip, Christopher Meaney, Rahim Valani, Mathew Mercuri

Open access · goldAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMC emergency medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.3field-weighted citation impact, top 20% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 8 citations in OpenAlex.

  1. Article
  2. Article
  3. Article
  4. Article
  5. Thromboelastography for the Prevention of Perioperative Venous Thromboembolism in Orthopedics.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 1 country.

Leila SalehiDepartment of Family Medicine, McMaster University, 100 Main Street West, 6th floor, Hamilton, Ontario, Canada. Leila.salehi@utoronto.ca.ORCID 0000-0003-1367-8155
Prashant PhalpherDepartment of Family Medicine, McMaster University, 100 Main Street West, 6th floor, Hamilton, Ontario, Canada.
Hubert YuDepartment of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, Canada.
Jeffrey JaskolkaDepartment of Diagnostic Imaging, William Osler Health System, 2100 Bovaird Avenue East, Brampton, Ontario, Canada.
Marc OssipDepartment of Diagnostic Imaging, William Osler Health System, 2100 Bovaird Avenue East, Brampton, Ontario, Canada.
Christopher MeaneyDepartment of Family Medicine, McMaster University, 100 Main Street West, 6th floor, Hamilton, Ontario, Canada.
Rahim ValaniDepartment of Emergency Medicine, William Osler Health System, Suite S.1.184, 2100 Bovaird Avenue East, Brampton, Ontario, Canada.
Mathew MercuriDivision of Emergency Medicine, McMaster University, Hamilton Health Sciences, McMaster Clinic, 2nd floor, 237 Barton Street East, Hamilton, Ontario, Canada.
William Osler Health System · CAUniversity of Toronto · CAHamilton Health Sciences · CAMcMaster University · CA

Funding

CIHR CDT-142654
6 · The paper itself

Abstract

backgroundA variety of evidence-based algorithms and decision rules using D-Dimer testing have been proposed as instruments to allow physicians to safely rule out a pulmonary embolism (PE) in low-risk patients.

objectiveTo describe the prevalence of D-Dimer utilization among emergency department (ED) physicians and its impact on positive yields and utilization rates of Computed Tomography Pulmonary Angiography (CTPA).

methodsData was collected on all CTPA studies ordered by ED physicians at three sites during a 2-year period. Using a chi-square test, we compared the diagnostic yield for those patients who had a D-Dimer prior to their CTPA and those who did not. Secondary analysis was done to examine the impact of D-Dimer testing prior to CTPA on individual physician diagnostic yield or utilization rate.

resultsA total of 2811 CTPAs were included in the analysis. Of these, 964 CTPAs (34.3%) were ordered without a D-Dimer, and 343 (18.7%) underwent a CTPA despite a negative D-Dimer. Those CTPAs preceded by a D-Dimer showed no significant difference in positive yields when compared to those ordered without a D-Dimer (9.9% versus 11.3%, p = 0.26). At the individual physician level, no statistically significant relationship was found between D-Dimer utilization and CTPA utilization rate or diagnostic yield.

conclusionThis study provides evidence of suboptimal adherence to guidelines in terms of D-Dimer screening prior to CTPA, and forgoing CTPAs in patients with negative D-Dimers. However, the lack of a positive impact of D-Dimer testing on either CTPA diagnostic yield or utilization rate is indicative of issues relating to the high false-positive rates associated with D-Dimer screening.

Indexed as

PhysiciansPulmonary EmbolismAngiographyComputed Tomography AngiographyEmergency Service, HospitalFibrin Fibrinogen Degradation ProductsHumansRetrospective StudiesFibrin Fibrinogen Degradation Productsfibrin fragment DBiomarkersComputed tomographyPhysicians practice patternsPulmonary embolismQuality improvement

Identifiers

PMID33468044
PMCPMC7814629
OpenAlexW3123679502

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.