Pulmonary embolism is a everyday m...

Pulmonary embolism is a everyday medical condition that is difficult to diagnose. Many diagnostic proofs are available to assist in establishing the diagnosis, on the contrary all of them have drawbacks, including poor sensitivity. The gold standard for diagnosis is angiography, still it is invasive and carries a 3 to 4 percent risk of cardiopulmonary complications. Helical comput tomographic (CT) scan has been used, nevertheless pulmonary embolism cannot be rul on the outside in patients with a negative scan. A newer proof for pulmonary embolism, the assay for plasma dimer, is a promising exclusion ordeal if the results are negative. The exhibition originally was limited by intraobserver variation and the subdued sensitivity of the rapid latex examples The newer tests for dimers are automated and more sensitive. Rathbun and colleagues evaluated the usefulness of an automated quantitative dimer experiment in the diagnosis of pulmonary embolism.

The trial was a prospective cohort reflection of consecutive patients admitted to brace medical centers with suspected pulmonary embolism. Patients from the outpatient and inpatient areas who were sent for a ventilation-perfusion or helical CT scan were eligible for the application of mind and were followed with an established protocol. Patients with a nondiagnostic lung scan or negative CT scan were enlisted in the study and had a dimer proof and compression ultrasonography. Patients with a negative ultrasound proof a positive dimer test, and adequate cardiorespiratory keep had repeat compression ultrasonography at five to seven days and again at 10 to 14 days. Anticoagulation therapy was withheld unles the ultrasound touchstone was positive. Those with inadequate cardiorespiratory lay by were recommended for pulmonary angiography.

Of the 444 patients cloaked for the study, 125 met the inclusion criteria. The dimer proof was negative in 14.4 percent of the 125 patients (11 of the 103 inpatients and seven of 22 outpatients). The dimer experiment was positive in all 11 patients who had a positive ultrasound proof Venous thromboembolism was confirmed in 146 percent of the cohort. Eleven percent of inpatients and 32 percent of outpatients had negative dimer ensues with a nondiagnostic lung scan or a negative helical CT scan.

The authors close that measurement of plasma dimer in inpatients who may have pulmonary embolism is of limited clinical value in patients who have a nondiagnostic lung scan or negative helical CT scan. They add that this may be because inpatients have a higher incidence of acute and chronic diseases that increase fibrin, which could alter the terminates of the dimer assay.

Rathbun SW et al. Clinical utility of dimer in patients with suspected pulmonary embolism and nondiagnostic lung scans or negative CT findings. Chest March 2004;125:851-5

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