期刊名称：General Internal Medicine and Clinical Innovations
电子版ISSN：2397-5237
出版年度：2016
卷号：1
期号：1
页码：12-15
DOI：10.15761-GIMCI.1000104
语种：English
出版社：Open Access Text
摘要：BackgroundVenous thromboembolism is a leading cause of morbidity and mortality in the United States. Accurate and timely diagnosis may be confounded by its nonspecific clinical presentation. Wells Criteria is a reliable screening tool with high sensitivity; however, recent data suggest that D-dimer is increasingly used as a primary screening test. While the sensitivity of D-dimer is comparable to Wells Criteria, it lacks specificity and positive predictive value, thus resulting in increased hospitalizations, further testing and accompanied costs and complications.AimsOur goal was to assess utilization of D-dimer and Wells criteria in the emergency department as a screening tool for venous thromboembolism.Materials and methodsThis is a retrospective chart review conducted at a community hospital. All patients who had a D-dimer test at presentation to the emergency department were included in the study. Fishcer’s Exact was used for statistical analysis.ResultsContrary to current recommendations, 15 patients (9.3%) with low Wells Score and negative D-dimer had further imaging studies. Increased use of imaging resulted in an increased cost of care and possible exposure to the procedure related complications.ConclusionsA review of the literature and our study both conclude that adherence to current guidelines for evaluation of venous thromboembolism is less than optimal. Adherence to the guidelines in evaluating these patients would have several beneficial outcomes including reducing the need for further imaging studies thus reducing healthcare costs and decreasing possible patient complications associated with such procedures.
