Stadt, E. A. van de (2016) Toepassing van de leeftijdsafhankelijke afkapwaarde van de D-dimeer bij de diagnostiek naar longembolieën in het Medisch Spectrum Twente : een retrospectief cohort onderzoek. thesis, Medicine.
Full text available on request.Abstract
Background: The diagnostic approach to the patient with a suspected pulmonary embolism (PE) is based on two pillars: clinical suspicion, where possible objectivated by a validated, clinical tool (the Wells score) and the D-dimer level in the blood. When there is a low clinical probability the D-dimer is the factor which decides whether or not a patient gets a CT-scan to exclude PE. In elderly patients, the D-dimer can be raised without the presence of PE, which makes this test less reliable in this group of patients. This can lead to more scans in this vulnerable group, with more complications and higher costs as a result. In recent years, many studies have researched the possibility of an age-dependent cut-off for the D-dimer in patients older than 50 years. These multi-center, international studies have shown that this can be done safely. However, the multicenter character of these studies has one big drawback: the labkits used to measure the D-dimer are not the same. To validate this age-dependent cutoff for the D-dimer in the MST, research is needed which uses the specific kit used here, the TinaQuant D-dimer 2nd generation. This study retrospectively researches the age-dependent cutoff for the D-dimer in the MST. Methods: The Radiology department provided us with a list of scanned patients in the period in which this labkit is used. From this list a cohort of 1033 patients was composed in which age, Wells score, D-dimer level and whether or not PE was present was registered. Based on this cohort sensitivity, specificity, positive predictive value and negative predictive value was calculated. Results: The results show that by implementing the age-dependent cutoff the sensitivity, specificity, positive predictive value and negative predictive value all increase. 3 patients were marked as fals-negative in the group where the age-dependent cutoff said they would not need a CT-scan. In 69 cases the CT-scan would not have taken place. Conclusion: Although the results are similar to the results found in international literature, we cannot without equivocation conclude that we can safely apply the age-dependent cutoff. Since the definition of “safe” is not given in the studies on which this research is based we cannot draw the conclusion that the age-dependent cutoff value for the D-dimer is safe to use in the MST.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider Eijsvogel, M.M. and Medisch Spectrum Twente afd. longziekten |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:04 |
| Last Modified: | 25 Jun 2020 11:04 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2364 |
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