Article

Valor del dímero-D para el diagnóstico de tromboembolismo pulmonar en el servicio de urgencias

01/2000;

ABSTRACT

Objective: The management of pulmonary thromboembolism
(PTE) is of great interest owing to the fact
that it is impossible to diagnose definitively on the basis
of the clinical presentation alone. We studied the diagnostic
yield of the determination of D-dimer when clinical signs
lead to the suspicion of PTE. Methods: A retrospective study
was carried out in 79 patients who came to the Emergency
Service of our hospital with suspected PTE. The clinical findings,
chest X-ray, electrocardiogram, arterial blood gases,
coagulation study, D-dimer level, contrast phlebography of lower
limbs and perfusion scintigraphy were assessed. Results:
Of the 79 patients, 45 (57%) were diagnosed as having PTE.
The determination of D-dimer showed a sensitivity of 93%, a
specificity of 50%, a positive predictive value (PPV) of 71%
and a negative predictive value (NPV) of 85%. According to
the criteria of the SEPAR, in patients with low and medium levels
of suspicion, the NPV of D-dimer was 100% and 90%,
respectively. In another population of interest, consisting of
those individuals in whom the results of lung scintigraphy
were not conclusive (low or intermediate probability), D-dimer
reached a NPV of 86%. Conclusions: In the Hospital Emergency
Service, the determination of the D-dimer level as a screening
test for PTE has an elevated NPV in cases of low or intermediate
clinical suspicion and in patients in whom lung scintigraphy
is inconclusive. Thus, this test is a useful diagnostic
tool in the management of venous thromboembolic disease.
Value

Download full-text

Full-text

Available from: Bernabé Jurado Gámez
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: To analyze the clinical, electrocardiographic, radiologic, and analytic characteristics of patients diagnosed with pulmonary thromboembolism and to compare them with previously published data. METHODS: Retrospective review of the hospital records of patients admitted with a presumptive diagnosis of pulmonary thromboembolism between January 1, 2004 and December 31, 2006. The data were analyzed using 5P55 software version 14.0. RESULTS: The diagnosis was confirmed in 83 patients. The patients mean (5D) age was 70.8 (15) years and 18.1 % had prior history of pulmonary thromboembolism or deep vein thrombosis. Active neoplastic disease was present in 15.7 of cases, a history of immobilization in 45.8%, chest pain in 31.3%, and syncope in 16.9%. No patient had hemoptysis. Signs of deep vein thrombosis were noted in 28.9%, venous insufficiency in the lower limbs in 20.5%, tachypnea 89.8%, tachycardia in 54.4%, S1Q3T3 in 23.1 %, right bundle-branch block in 16.7%, negative precordial T waves in 15.4%, raised hemidiaphragm in 22.8%, basal atelectasis in 4.8%, pleural effusion in 16.9%, PaO2 < 60 mmHg in 30.9%, and PaCO2 < 35 mmHg in 48.1 %. Computed tomography angiography showed involvement of the central pulmonary vessels in 51.8% and bilateral and multiple involvement in 45.8%. Overall, 30-day mortality was 7.2%. CONCLUSIONS: Our patients presented characteristics that were different from those of other published series. They were older, had a higher rate of syncope, absence of hemoptysis, a low rate of massive pulmonary thromboembolism, a low mortality at 30 days. These data suggest the need for prospective multicenter studies that would allow us to validate new pretest scales of diagnostic probability for the Spanish population. OBJETIVO: Analizar las características clínicas, electrocardiográficas, radiológicas y analíticas de los pacientes que fueron diagnosticados de tromboembolismo pulmonar (TEP) para ver si se ajustan a los referidos en la literatura previa. METODOLOGÍA: Se revisaron de manera retrospectiva los informes de alta hospitalaria de los pacientes que ingresaron con la sospecha diagnóstica de TEP, del 1 de enero del 2004 al 31 de diciembre del 2006. Los datos fueron analizados con el paquete estadístico SPSS 14,0. RESULTADOS: Se confirmó el diagnóstico en 83 pacientes. La edad media fue 70,8 ± 15 años. Tenían historia previa de TEP o trombosis venosa profunda (TVP) 18,1%, de neoplasia activa previa el 15,7%, de inmovilización el 45,8%, de dolor torácico el 31,3%, de síncope el 16,9%. En ningún caso se registró hemoptisis. En la exploración se encontraron signos de TVP en el 28,9%, insuficiencia venosa en extremidades inferiores en el 20,5%, taquipnea en el 89,8%, taquicardia en 54,4%. En el ECG se encontró S1Q3T3 en el 23,1%, bloqueo de rama derecha en el 16,7%, ondas T negativas en precordiales en el 15,4%. En la radiografía de tórax se observó elevación del hemidiafragma en el 22,8%, atelectasias basales en el 4,8%, derrame pleural en el 16,9%. En la gasometría existía PaOz < 60 en el 30,9%, PaCOz < 35 en el 48,1%. En la angiotomografía presentaron afectación de los vasos pulmonares centrales un 51,8% y en un 45,8% la localización fue bilateral y múltiple. La mortalidad global a los 30 días fue del 7,2%. CONCLUSIONES: Nuestros pacientes presentan características diferenciales con respecto a series previas. A destacar su mayor edad, la alta tasa de cuadros sincopales, la ausencia de casos de hemoptisis, la baja tasa de TEP masivos y la escasa mortalidad a los 30 días. Estos datos sugieren la necesidad de estudios prospectivos multicéntricos que permitan validar el empleo de nuevas escalas de probabilidad diagnóstica pretest en la población española.
    Full-text · Article ·
  • Source

    Preview · Article · Jan 2002 · Anales de medicina interna (Madrid, Spain: 1984)
  • Source

    Full-text · Article · Jan 2002 · Anales de medicina interna (Madrid, Spain: 1984)
Show more