• Camilla J Stockley, Matthew J Reed, David E Newby, Andrew J Coull, Gareth R Clegg, and Alasdair J Gray.
• Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, UK
• Eur J Emerg Med. 2009 Oct 1; 16 (5): 256-60.

AimTo establish whether D-dimer is an independent predictor of 1-month serious outcome and all-cause death in syncope patients presenting to the emergency department (ED).MethodsThis was a prospective cohort study of all adults presenting with syncope to an ED in the UK. Plasma D-dimer concentrations were determined in citrated plasma obtained at presentation. The primary endpoint was the combination of serious outcome and all-cause death at 1 month.ResultsOf 237 patients enrolled, 205 patients had a suitable plasma sample and had complete follow-up. Seventeen patients had a serious outcome or death at 1 month including three patients with a pulmonary embolus and eight with a serious cardiovascular outcome. Nearly a half of all patients (n=94; 46%) had a plasma D-dimer concentration above the upper limit of normal, 10 of whom had a serious outcome or death at 1 month. Receiver-operator characteristic curve analysis showed no relationship between plasma D-dimer concentration and serious outcome or death at 1 month. An elevated plasma D-dimer concentration was found in all patients with a pulmonary embolus.ConclusionPlasma D-dimer is frequently raised in patients presenting with syncope to the ED and consequently does not predict 1-month serious outcome or death. We conclude that there is no role for the routine measurement of D-dimer in the management of patients presenting to the ED with syncope.

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