Pre- and post-test probabilities of venous thromboembolism and diagnostic accuracy of D-dimer, estimated by European clinicians working in emergency departments

Detalhes bibliográficos
Autor(a) principal: Kristoffersen, Ann Helen
Data de Publicação: 2017
Outros Autores: Ajzner, Eva, Bauça, Josep Miquel, Carraro, Paolo, Faria, Ana Paula, Hillarp, Andreas, Rogic, Dunja, Sozmen, Eser Y., Watine, Joseph, Meijer, Piet, Sandberg, Sverre
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10400.18/5117
Resumo: Letter to the Editors-in-Chief
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spelling Pre- and post-test probabilities of venous thromboembolism and diagnostic accuracy of D-dimer, estimated by European clinicians working in emergency departmentsVenous ThromboembolismStandardized Scoring SchemesD-dimerPre-test ProbabilityPost-test ProbabilityLikelihood RatioDeep Venous ThrombosisPulmonary EmbolismAvaliação Externa da QualidadeAEQPrograma Nacional de Avaliação Externa da QualidadePNAEQLetter to the Editors-in-ChiefIntroduction: In patients with suspected venous thromboembolism (VTE), it is recommended to estimate the pre-test probability of VTE, either by experience or by standardized scoring schemes (e.g. Wells or Geneva score), before performing a D-dimer test. Patients with a low probability or unlikely VTE should have D-dimer performed, and if negative, VTE can be excluded, without further investigations, while if positive, the patient should be referred to radiologic imaging to confirm or exclude VTE. Patients with a high pre-test probability or likely VTE should be referred directly to radiologic imaging without D-dimer testing. Thus, to estimate the pre-test probability of VTE before D-dimer testing is of uttermost importance since the diagnostic algorithm and the interpretation of the D-dimer result is dependent upon this. Further, the diagnostic accuracy of D-dimer can be expressed by the likelihood ratio (LR). LR is the ratio between the probability of a test result given that VTE is present, and probability of the same test result if VTE is absent. A LR of< 1 decreases the probability of disease and a LR of> 1 increases the probability of disease. When clinicians estimate the pre-test probability for VTE, the post-test probability (after D-dimer testing) can be calculated using the LR for D-dimer either for a positive or negative test (i.e. D-dimer above or below the cut-off level, respectively). Probably, most clinicians do not know the LR for D-dimer, but it is indirectly implemented in the above mentioned algorithm for investigating a patient with suspected VTE. The advice to rule out VTE in a patient if the pre-test probability of VTE is low and the D-dimer is below the cut-off level reflects that the post-test probability of VTE in this case is sufficiently low to rule out VTE (should be< 1-2%). However, if the pre-test probability of VTE is high or likely, a negative D-dimer cannot decrease the post-test probability enough to rule out VTE (the post-test probability will still be about 10%) [4,5]. Therefore, only imaging should be requested when pre-test probability of VTE is high. A positive D-dimer cannot increase post-test probability of VTE enough to confirm VTE diagnosis in any case, since D-dimer is a non-specific VTE marker and levels can be increased in several other clinical situations (e.g. infection, inflammation, cancer and pregnancy). The aims of this survey were 1) to study the relationship between pre-test probabilities estimated by clinicians using two case histories and how the same clinicians' categorized the patients into low, moderate or high probability of VTE or into unlikely or likely VTE, and 2) to examine the clinicians' perception of diagnostic accuracy of D-dimer by calculating the LRs based upon their estimated pre- and post-test probabilities.Elsevier/European Thrombosis Research Organisation (ETRORepositório Científico do Instituto Nacional de SaúdeKristoffersen, Ann HelenAjzner, EvaBauça, Josep MiquelCarraro, PaoloFaria, Ana PaulaHillarp, AndreasRogic, DunjaSozmen, Eser Y.Watine, JosephMeijer, PietSandberg, Sverre2021-09-19T00:30:11Z2017-112017-11-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.18/5117engThromb Res. 2017 Nov;159:19-23. doi:10.1016/j.thromres.2017.09.012. Epub 2017 Sep 18.10.1016/j.thromres.2017.09.012info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-07-20T15:40:40Zoai:repositorio.insa.pt:10400.18/5117Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T18:39:50.392030Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Pre- and post-test probabilities of venous thromboembolism and diagnostic accuracy of D-dimer, estimated by European clinicians working in emergency departments
title Pre- and post-test probabilities of venous thromboembolism and diagnostic accuracy of D-dimer, estimated by European clinicians working in emergency departments
spellingShingle Pre- and post-test probabilities of venous thromboembolism and diagnostic accuracy of D-dimer, estimated by European clinicians working in emergency departments
Kristoffersen, Ann Helen
Venous Thromboembolism
Standardized Scoring Schemes
D-dimer
Pre-test Probability
Post-test Probability
Likelihood Ratio
Deep Venous Thrombosis
Pulmonary Embolism
Avaliação Externa da Qualidade
AEQ
Programa Nacional de Avaliação Externa da Qualidade
PNAEQ
title_short Pre- and post-test probabilities of venous thromboembolism and diagnostic accuracy of D-dimer, estimated by European clinicians working in emergency departments
title_full Pre- and post-test probabilities of venous thromboembolism and diagnostic accuracy of D-dimer, estimated by European clinicians working in emergency departments
title_fullStr Pre- and post-test probabilities of venous thromboembolism and diagnostic accuracy of D-dimer, estimated by European clinicians working in emergency departments
title_full_unstemmed Pre- and post-test probabilities of venous thromboembolism and diagnostic accuracy of D-dimer, estimated by European clinicians working in emergency departments
title_sort Pre- and post-test probabilities of venous thromboembolism and diagnostic accuracy of D-dimer, estimated by European clinicians working in emergency departments
author Kristoffersen, Ann Helen
author_facet Kristoffersen, Ann Helen
Ajzner, Eva
Bauça, Josep Miquel
Carraro, Paolo
Faria, Ana Paula
Hillarp, Andreas
Rogic, Dunja
Sozmen, Eser Y.
Watine, Joseph
Meijer, Piet
Sandberg, Sverre
author_role author
author2 Ajzner, Eva
Bauça, Josep Miquel
Carraro, Paolo
Faria, Ana Paula
Hillarp, Andreas
Rogic, Dunja
Sozmen, Eser Y.
Watine, Joseph
Meijer, Piet
Sandberg, Sverre
author2_role author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Repositório Científico do Instituto Nacional de Saúde
dc.contributor.author.fl_str_mv Kristoffersen, Ann Helen
Ajzner, Eva
Bauça, Josep Miquel
Carraro, Paolo
Faria, Ana Paula
Hillarp, Andreas
Rogic, Dunja
Sozmen, Eser Y.
Watine, Joseph
Meijer, Piet
Sandberg, Sverre
dc.subject.por.fl_str_mv Venous Thromboembolism
Standardized Scoring Schemes
D-dimer
Pre-test Probability
Post-test Probability
Likelihood Ratio
Deep Venous Thrombosis
Pulmonary Embolism
Avaliação Externa da Qualidade
AEQ
Programa Nacional de Avaliação Externa da Qualidade
PNAEQ
topic Venous Thromboembolism
Standardized Scoring Schemes
D-dimer
Pre-test Probability
Post-test Probability
Likelihood Ratio
Deep Venous Thrombosis
Pulmonary Embolism
Avaliação Externa da Qualidade
AEQ
Programa Nacional de Avaliação Externa da Qualidade
PNAEQ
description Letter to the Editors-in-Chief
publishDate 2017
dc.date.none.fl_str_mv 2017-11
2017-11-01T00:00:00Z
2021-09-19T00:30:11Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10400.18/5117
url http://hdl.handle.net/10400.18/5117
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Thromb Res. 2017 Nov;159:19-23. doi:10.1016/j.thromres.2017.09.012. Epub 2017 Sep 18.
10.1016/j.thromres.2017.09.012
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier/European Thrombosis Research Organisation (ETRO
publisher.none.fl_str_mv Elsevier/European Thrombosis Research Organisation (ETRO
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron:RCAAP
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron_str RCAAP
institution RCAAP
reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
repository.mail.fl_str_mv
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