Excluding venous thromboembolism using point of care D-dimer tests in outpatients: a diagnostic meta-analysis
BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2990 (Published 14 August 2009) Cite this as: BMJ 2009;339:b2990
- G J Geersing, general practitioner 1,
- K J M Janssen, clinical epidemiologist1,
- R Oudega, general practitioner1,
- L Bax, clinical epidemiologist 12,
- A W Hoes, professor of clinical epidemiology and primary care1,
- J B Reitsma, clinical epidemiologist3,
- K G M Moons, professor of clinical epidemiology 1
- 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- 2Kitasato Clinical Research Center, Kitasato University, Japan
- 3Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Correspondence to: G J Geersing g.j.geersing{at}umcutrecht.nl
- Accepted 28 April 2009
Abstract
Objective To review the evidence on the diagnostic accuracy of the currently available point of care D-dimer tests for excluding venous thromboembolism.
Design Systematic review of research on the accuracy of point of care D-dimer tests, using bivariate regression to examine sources of variation and to estimate sensitivity and specificity.
Data sources Studies on the diagnostic accuracy of point of care D-dimer tests published between January 1995 and September 2008 and available in either Medline or Embase.
Review methods The analysis included studies that compared point of care D-dimer tests with predefined reference criteria for venous thromboembolism, enrolled consecutive outpatients, and allowed for construction of a 2×2 table.
Results 23 studies (total number of patients 13 959, range in mean age 38-65 years, range of venous thromboembolism prevalence 4-51%) were included in the meta-analysis. The studies reported two qualitative point of care D-dimer tests (SimpliRED D-dimer (n=12) and Clearview Simplify D-dimer (n=7)) and two quantitative point of care D-dimer tests (Cardiac D-dimer (n=4) and Triage D-dimer (n=2)). Overall sensitivity ranged from 0.85 (95% confidence interval 0.78 to 0.90) to 0.96 (0.91 to 0.98) and overall specificity from 0.48 (0.33 to 0.62) to 0.74 (0.69 to 0.78). The two quantitative tests Cardiac D-dimer and Triage D-dimer scored most favourably.
Conclusions In outpatients suspected of venous thromboembolism, point of care D-dimer tests can contribute important information and guide patient management, notably in low risk patients (that is, those patients with a low score on a clinical decision rule).
Footnotes
Contributors: GJG, KJMJ, and RO participated in study concept and design, acquisition of data, analysis and interpretation of data, and drafting of the manuscript. JBR and LB participated in study concept and design and analysis and interpretation of data, and provided statistical expertise and critical revision of the manuscript. KGMM and AWH participated in study concept and design, analysis and interpretation of data, critical revision of the manuscript, and study supervision.
Funding: Financial support was provided by the Netherlands Heart Foundation (project number 2006B237) and “Zilveren Kruis Achmea” (project number Z195). These organisations had no influence on any aspect of this study.
Competing interests: The authors have conducted previous studies with point of care D-dimer tests and have received Clearview Simplify D-dimer, Cardiac D-dimer, and Triage D-dimer testkits free of charge for study purposes. Manufacturers, however, were in no way involved in the meta-analysis.
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