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  • A normal alveolar dead space fraction plus d-dimer assay ruled out suspected pulmonary embolism in the emergency department

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Diagnosis
A normal alveolar dead space fraction plus d-dimer assay ruled out suspected pulmonary embolism in the emergency department

https://doi.org/10.1136/ebm.6.5.158

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    (2001) JAMA 285, 761; Kline JA, Israel EG, Michelson EA, et al.. Diagnostic accuracy of a bedside . d. -dimer assay and alveolar dead-space measurement for rapid exclusion of pulmonary embolism: a multicenter study. . Feb 14;. :. –8.
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 QUESTION: In patients with suspected pulmonary embolism (PE) who are in the emergency department, can a normal alveolar dead space fraction (ADF) assessment and a negative whole blood agglutination d-dimer assay exclude PE?

    Design

    Blinded comparison of test results for ADF and d-dimer assay with radionuclide lung scanning (V/Q scan), contrast enhanced computer tomography, and 6 month follow up plus selective use of venous ultrasonography and pulmonary angiography.

    Setting

    6 urban teaching hospitals in the US.

    Patients

    380 patients (mean age 50 y, 70% women) with suspected PE. Inclusion criteria were age >18 years and not being transferred from another facility. Exclusion criteria were signs of circulatory shock, inability to breathe room air and maintain pulse oximetry reading of < 90%, or failure to cooperate …

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    Footnotes

    • Sources of funding: Emergency Medicine Foundation and Novametrix Corporation.

    • For correspondence: Dr J A Kline, Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28232-2816, USA. Fax +1 704 355 3039.