[Diagnostic accuracy of fibrin D-dimer]

Area of Science:

• Emergency Medicine
• Clinical Diagnostics
• Hematology

Background:

• Dyspnoea and chest pain are common, non-specific emergency department presentations.
• Potential causes include myocardial infarction, aortic dissection, pulmonary embolism, and infection.
• Fibrin D-dimer is frequently used to exclude acute thromboembolic disease.

Purpose of the Study:

• To review current approaches for utilizing fibrin D-dimer in emergency diagnostics.
• To highlight challenges and potential errors in interpreting fibrin D-dimer results.
• To improve the diagnostic accuracy for patients presenting with chest pain and dyspnoea.

Main Methods:

• Literature review of diagnostic guidelines and clinical studies.
• Analysis of fibrin D-dimer's performance in various age groups.
• Examination of factors affecting test specificity and clinical utility.

Main Results:

• Fibrin D-dimer's specificity decreases significantly with age, reaching ~10% in 80-year-olds.
• Interpretation requires careful consideration of patient age and pre-test probability.
• Pitfalls exist in both the utilization and interpretation of the test.

Conclusions:

• Fibrin D-dimer is a valuable screening tool but requires cautious interpretation, particularly in the elderly.
• Understanding its limitations is crucial for accurate diagnosis in emergency settings.
• Optimizing fibrin D-dimer use can enhance the work-up of dyspnoea and chest pain.