• Acad Emerg Med · Mar 2011

    Comparative Study

    Effect of two different FDA-approved D-dimer assays on resource utilization in the emergency department.

    • Leon D Sanchez, Daniel C McGillicuddy, Kathryn A Volz, Shu-Ling Fan, Nina Joyce, and Gary L Horowitz.
    • Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. leon_sanchez@bidmc.harvard.edu
    • Acad Emerg Med. 2011 Mar 1; 18 (3): 317-21.

    BackgroundThe D-dimer assay has been shown to be an appropriate test to rule out pulmonary embolism (PE) in low-risk patients in the emergency department (ED). Multiple assays now are approved to measure D-dimer levels. Studies have shown a newer assay, Tina-quant, to have similar diagnostic accuracy to the VIDAS assay.ObjectivesThe objective was to determine effects of transitioning from the VIDAS assay to the Tina-quant D-dimer assay on the need for computed tomography angiogram (CTA) and ED length of stay (LOS) in patients being evaluated for PE in the ED.MethodsA retrospective cohort study was conducted of patients who had D-dimer levels ordered at an urban, academic, Level I trauma center with over 55,000 annual ED visits. The results of D-dimer levels in the ED were recorded over a period of 6 months prior to and 6 months after the transition to the new D-dimer assay. The numbers of positive and negative D-dimers and need for subsequent CTAs were recorded for comparison. LOS was also recorded to determine time saved. Medians were calculated and compared using Wilcoxon rank sum.ResultsDuring the initial period, 875 D-dimers were ordered, with a positive rate of 41.5%. During the period after the introduction of the Tina-quant assay, 859 tests were ordered, with 25.5% having positive results. An absolute decrease of 16% in the number of necessary CTAs (p < 0.003) was seen after the transition to the Tina-quant assay. LOS data showed a mean LOS of 481 minutes in the ED for patients who underwent testing with the Tina-quant assay compared to 526 minutes with the VIDAS assay, saving an average of 45 minutes per patient (p < 0.003). The positive rate on performed imaging studies for D-dimer of > 500 rose from 13 of 308 (4.2%) to 17 of 187 (9.1%).ConclusionsSwitching D-dimer assays reduced both LOS and number of imaging studies in our patient population.© 2011 by the Society for Academic Emergency Medicine.

      Pubmed     Free full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…