Does implementation of a diagnostic pathway for acute aortic syndrome including D-dimer increase the usage of D-dimer
Robert Ohle1, Nicholas Fortino2, Sarah McIsaac3
1The Department of Emergency Medicine, Health Science North Research Institute, Northern Ontario School of Medicine, 41 Ramsey Lake Rd, Sudbury, ON, P3E 5J1, Canada. Robert.ohle@gmail.com.
Insights
Implementing a new diagnostic pathway for acute aortic syndrome using D-dimer did not significantly increase testing. This approach aids in risk stratification without immediate resource strain.
Area of Science:
- Emergency Medicine
- Cardiology
- Diagnostic Pathways
Background:
- Acute aortic syndrome (AAS) diagnosis requires effective risk stratification.
- Canadian guidelines propose a novel pathway using a clinical decision tool and D-dimer for AAS.
- Assessing the impact of implementing such a pathway in a tertiary care setting is crucial.
Purpose of the Study:
- To evaluate the implementation of a diagnostic pathway for AAS.
- To determine if the pathway increases D-dimer and computed tomography (CT) utilization.
- To assess changes in pretest probability documentation.
Main Methods:
- Prospective, single-center, before-and-after study.
- Recruited patients over a 6-week period in a tertiary care emergency department.
- Compared D-dimer and CT usage pre- and post-intervention.
Main Results:
- D-dimer testing increased from 6.9% to 10.4% (p<0.051).
- CT aorta usage remained stable at 0.6% (p=0.60).
- Documentation of pretest probability assessment significantly increased from 1% to 3% (p<0.009).
Conclusions:
- The AAS diagnostic pathway with D-dimer can be implemented without significant immediate increase in test ordering.
- Findings support the use of D-dimer for AAS risk stratification.
- Further research is needed to confirm diagnostic accuracy and long-term resource impact.
Introduction:
The Canadian clinical practice guidelines propose a novel diagnostic pathway incorporating a clinical decision tool and D-dimer to aid in risk stratifying patients for acute aortic syndrome. The objective of this study was to assess if implementation of a diagnostic pathway incorporating D-dimer would increase the usage of D-dimer and computed tomography (CT) in a tertiary care emergency department.
Methods:
Prospective single centre before and after study-recruiting patients over a 6-week period from a tertiary care emergency department.
Intervention:
multi model implementation of a diagnostic pathway for acute aortic syndrome incorporating D-dimer.
Outcome:
proportion of patients receiving D-dimer testing/CT in the 2 weeks before and after implementation.
Results:
We included 982 patients (Female 55%, Age mean 51.9, N = 492 pre intervention and N = 490 post intervention). The proportion that received a D-dimer test increased from 6.9 to 10.4% (p < 0.051), while the number of CT aortas remained stable (0.6% vs. 0.6%; p = 0.60). Documentation of pretest probability assessment increased from 1 to 3%, (p < 0.009) following the intervention. In the post intervention cohort, the tool was applied correctly in all cases (N = 17).
Conclusion:
This single centre study found that a diagnostic pathway for acute aortic syndrome including D-dimer could be implemented without a significant increase in test ordering during this first 2 weeks after implementation. This study adds to the argument for use of D-dimer to help risk stratify patients for the diagnosis of acute aortic syndrome. Future studies are needed to confirm the diagnostic accuracy of this pathway and the long-term impact on resource utilization.
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