Another resident perspective: resident education and the pharmaceutical industry.
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Biomedical subjects
Publications and source records attributed to Erik B Kulstad.
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Many rapid d-dimer assays are commercially available with wide ranges of reported sensitivities, often based on small sample sizes. This has limited their intended use as rapid and inexpensive tests to evaluate pulmonary embolism in the low-risk patient. We sought to determine the sensitivity of the STA-Liatest D-Di d-dimer assay in our ED. We performed a retrospective analysis of 103 patients seen in our ED with the admitting diagnosis of known or suspected pulmonary embolism. These charts were assessed to establish if a d-dimer assay was performed within 24 hours. These charts were then reviewed to determine what diagnostic studies were performed and what final diagnosis was reached. Of the 103 charts identified, 55 had d-dimer assays performed within 24 hours. Of those, 38 were diagnosed with pulmonary embolism; none had negative d-dimer assays (<400 ng/mL). Using the exact method, the sensitivity of this assay was calculated to be 100% with a 95% confidence interval (CI) of 91.4% to 100%. Our results suggest that the STA-Liatest D-Di d-dimer assay could have an adequate sensitivity to be used to rule out pulmonary embolism in low-risk patients. Further prospective studies with larger sample sizes are required to validate this observation.
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The use of B-type natriuretic peptide to diagnose congestive heart failure is becoming more frequent and widespread. We report five patients recently seen at our hospital who were diagnosed with pulmonary embolism and noted to have elevated B-type natriuretic peptide levels. We caution that elevations of B-type natriuretic peptide may in some patients have the potential to mislead clinicians if the diagnosis of pulmonary embolism is not considered.
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