Excluding venous thromboembolism using point of care D-dimer tests in outpatients: a diagnostic meta-analysis

被引:99
作者
Geersing, G. J. [1 ]
Janssen, K. J. M. [1 ]
Oudega, R. [1 ]
Bax, L. [1 ,2 ]
Hoes, A. W. [1 ]
Reitsma, J. B. [3 ]
Moons, K. G. M. [1 ]
机构
[1] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands
[2] Kitasato Univ, Kitasato Clin Res Ctr, Tokyo, Japan
[3] Univ Amsterdam, Acad Med Ctr, Dept Clin Epidemiol & Biostat, NL-1105 AZ Amsterdam, Netherlands
来源
BMJ-BRITISH MEDICAL JOURNAL | 2009年 / 339卷
关键词
DEEP-VEIN THROMBOSIS; SUSPECTED PULMONARY-EMBOLISM; CLINICAL PROBABILITY; PATIENT; SENSITIVITY; REVIEWS; ASSAY; BIAS;
D O I
10.1136/bmj.b2990
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective To review the evidence on the diagnostic accuracy of the currently available point of care D-dimer tests for excluding venous thromboembolism. Design Systematic review of research on the accuracy of point of care D-dimer tests, using bivariate regression to examine sources of variation and to estimate sensitivity and specificity. Data sources Studies on the diagnostic accuracy of point of care D-dimer tests published between January 1995 and September 2008 and available in either Medline or Embase. Review methods The analysis included studies that compared point of care D-dimer tests with predefined reference criteria for venous thromboembolism, enrolled consecutive outpatients, and allowed for construction of a 2 x 2 table. Results 23 studies (total number of patients 13 959, range in mean age 38-65 years, range of venous thromboembolism prevalence 4-51%) were included in the meta-analysis. The studies reported two qualitative point of care D-dimer tests (SimpliRED D-dimer (n=12) and Clearview Simplify D-dimer (n=7)) and two quantitative point of care D-dimer tests (Cardiac D-dimer (n=4) and Triage D-dimer (n=2)). Overall sensitivity ranged from 0.85 (95% confidence interval 0.78 to 0.90) to 0.96 (0.91 to 0.98) and overall specificity from 0.48 (0.33 to 0.62) to 0.74 (0.69 to 0.78). The two quantitative tests Cardiac D-dimer and Triage D-dimer scored most favourably. Conclusions In outpatients suspected of venous thromboembolism, point of care D-dimer tests can contribute important information and guide patient management, notably in low risk patients (that is, those patients with a low score on a clinical decision rule).
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