Document Type
Project
Publication Date
2024
Abstract
Purpose: The aim of this literature review was to examine the diagnostic accuracy and clinical impact of medical providers ordering compression ultrasonography (CUS) exams for the lower extremity venous systems based on a patient’s positive D-dimer assay test.
Method: A systematic review of the current literature was conducted from September 2023-May 2024 using various search engines without language or date restrictions. From 30 sources inspected, articles were excluded from the research if they did not have statistics relating the positive or negative results of the D-dimer to the pretest clinical probability assessments and results of the following CUS exams. 20 sources met the inclusion criteria for this review.
Results: Across three of the studies with the biggest sample size, it was found that the percentage of patients who had a positive D-dimer and a positive diagnosis of PE, DVT, or VTE were below 25%. It was also found that D-dimer testing still faces ambiguity regarding age-adjusted threshold values, a lack of a universally standardized unit of measure, and differing levels of testing sensitivity and specificity across different commercial brands of D-dimer assays.
Conclusion: Throughout the research done thus far, there is still varying information regarding the effectiveness of D-dimers due to the wide variety of D-dimer assay types that are commercially available. The push for both the standardization of D-dimer threshold values as well as age-adjusted D-dimer threshold values will further optimize this test to reduce the rate of false positives. Most of the literature reflect an overlying theme that D-dimers are most useful in a setting where the test is administered alongside a clinical probability score to determine if a CUS is necessary to further evaluate for DVT, PE, and VTE. This method is most effective once a medical institution has a firm idea of the threshold values of their D-dimer tests for different age groups.
Recommended Citation
Nakasone, Jacob, "Systematic Review of Diagnostic Accuracy and Clinical Impact of Ordering Compression Ultrasonography Exams Based on a Positive D-dimer Assay Test" (2024). Diagnostic Ultrasound Projects. 6.
https://scholarworks.seattleu.edu/dius-projects/6