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The utility of routine D-dimer measurement in syncope
Camilla J Stockley1, Matthew J Reed, David E Newby
1Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, UK
Summary
D-dimer levels are often elevated in emergency department syncope patients but do not predict serious outcomes or death. Routine D-dimer measurement is not recommended for these patients.
Area of Science:
- Emergency Medicine
- Cardiology
- Clinical Diagnostics
Background:
- Syncope is a common presentation to emergency departments.
- Predicting serious outcomes in syncope patients is crucial for effective management.
- The utility of D-dimer testing in syncope evaluation is debated.
Purpose of the Study:
- To determine if D-dimer is an independent predictor of 1-month serious outcomes and all-cause death in patients presenting with syncope.
- To assess the role of D-dimer in the diagnostic workup of syncope in the emergency department.
Main Methods:
- Prospective cohort study of adult syncope patients in a UK emergency department.
- Plasma D-dimer concentrations measured at presentation.
- Primary endpoint: composite of serious outcome and all-cause death at 1 month.
Main Results:
- 17 out of 205 patients (8.3%) experienced a serious outcome or death at 1 month.
- Elevated D-dimer was observed in 46% of patients; 10% of these had a serious outcome or death.
- Receiver-operator characteristic analysis showed no predictive value of D-dimer for serious outcomes or death.
- All patients with pulmonary embolism had an elevated D-dimer.
Conclusions:
- Plasma D-dimer is frequently elevated in syncope patients but does not predict 1-month serious outcome or death.
- Routine D-dimer measurement has no role in managing emergency department patients with syncope.
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