Pulmonary embolism diagnosis with D-dimer levels and computed tomography

Pulmonary embolism (PE), a common heart and blood vessel disease, causes complications such as haemodynamic instability and cardiovascular mortality. Timely diagnosis and treatment are imperative for managing this potentially life-threatening condition.

The aim of this study was to establish the relationship between an elevated D-dimer level and a positive computed tomography pulmonary angiogram (CTPA), which could confirm PE in patients with chest pain and suspected PE.

Data were collected at a private diagnostic radiology practice located in Bloemfontein, South Africa.

Data were retrospectively collected from the Picture Archiving and Communications System (PACS).

Of the sampled patients (n = 1219), only 16.7% were diagnosed with PE after CTPA. Approximately 14% of the D-dimer-positive patient group were diagnosed with PE and, in the D-dimer-negative patient group, approximately 20% of the patients were diagnosed with PE. Of the patients sampled, 86% were not diagnosed with PE despite having increased D-dimer values. No specific trends in the relation between elevated D-dimer levels and a positive PE diagnosis could be identified at the significance level of 0.05; a Chi-square test of independence indicated (χ² [1, N = 995] = 1.84, p = 0.175).

No strong relationship between elevated D-dimer levels in the blood and a positive yield of PE after CTPA; was found hence, clinical decision rules for PE workups need refining, especially to limit unnecessary CTPA referrals in this setting.

The findings suggest that PE workup at the private practice should be revised to improve the quality of service.