ArticleBMC emergency medicine2025
Pre-CT risk stratification using the D-dimer/pCO₂ ratio in D-dimer-positive emergency department patients: diagnostic accuracy study.
Article in BMC emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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.
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.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe diagnostic utility of the D-dimer/pCO₂ ratio for pulmonary embolism (PE) risk stratification has not been fully established. This study evaluated its diagnostic performance among emergency department patients with positive age-adjusted D-dimer results undergoing computed tomography pulmonary angiography (CTPA).
methodsThis retrospective diagnostic accuracy study included 698 adult patients with positive age-adjusted D-dimer results, venous blood gas (VBG) pCO₂ measurements, and definitive CTPA interpretation. The D-dimer/pCO₂ ratio was calculated, and receiver operating characteristic (ROC) analysis was performed. Optimal and exploratory thresholds were assessed for overall PE detection and for excluding central PE. Robustness was tested using bootstrap validation and subgroup AUC comparisons. Decision curve analysis (DCA) was applied to evaluate clinical utility.
resultsPE was confirmed in 90 patients (12.9%). The ratio demonstrated good discrimination (AUC: 0.811, 95% CI: 0.775-0.847). At the optimal cut-off (44.91), sensitivity was 82.2% and specificity 71.1%, with a negative predictive value (NPV) of 96.4%. A lower cut-off (18.1) identified 91 patients with no observed PE (0/91; 95% CI upper bound for false negatives ≈ 4.0%). A higher threshold (61.25) identified 515 patients below this value, among whom no central PE was observed (0/515; 95% CI upper bound ≈ 0.7%). Discriminative ability was preserved across age groups (AUC range: 0.737-0.836). DCA showed modest, range-specific net benefit for incorporating the ratio within a low-to-intermediate threshold band.
conclusionIn D-dimer-positive ED patients already being considered for CTPA, the D-dimer/pCO₂ ratio is an adjunctive imaging triage indicator rather than a stand-alone test and may help inform the imaging workflow in this defined context. These findings should not be extrapolated to D-dimer-negative patients or those with very high pretest probability.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.