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Diagnosis
Review: a low clinical probability plus a normal D-dimer test result excludes a diagnosis of deep venous thrombosis

https://doi.org/10.1136/ebm.10.3.89

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    Fancher TL, White RH, Kravitz RL. Combined use of rapid D-dimer testing and estimation of clinical probability in the diagnosis of deep vein thrombosis: systematic review. BMJ 2004;329:821.
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 Q In patients with suspected deep venous thrombosis (DVT), is a combination of rapid D-dimer testing with estimation of clinical probability accurate for excluding a diagnosis of DVT?

    Clinical impact ratings IM/Ambulatory care ★★★★★★☆ Internal medicine ★★★★★★☆ Emergency Medicine ★★★★★☆☆ Haematology ★★★★★☆☆

    METHODS

    Embedded ImageData sources:

    Medline (1993–2003), Database of Abstracts and Reviews, and bibliographies of relevant articles.

    Embedded ImageStudy selection and assessment:

    prospective studies (published in English) that used a rapid D-dimer assay on at least a subgroup of consecutive outpatients with features of DVT; estimated the risk of DVT using a validated clinical probability tool that categorised patients as having low, intermediate, or high risk of DVT; evaluated outpatient data separately if inpatients were included; evaluated DVT data separately if patients with pulmonary embolism were included; had 100% patient follow up at ⩾3 months; documented DVT using ultrasonography, venography, or impedance plethsmography; and presented sufficient data for calculation of sensitivity and specificity of the D-dimer assay …

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