Excluding venous thromboembolism using point of care D-dimer tests in outpatients: a diagnostic meta-analysis

doi:10.1136/bmj.b2990

Published 14 August 2009, doi:10.1136/bmj.b2990
Cite this as: BMJ 2009;339:b2990

Research

Excluding venous thromboembolism using point of care D-dimer tests in outpatients: a diagnostic meta-analysis

G J Geersing, general practitioner ¹, K J M Janssen, clinical epidemiologist¹, R Oudega, general practitioner¹, L Bax, clinical epidemiologist ¹^,2, A W Hoes, professor of clinical epidemiology and primary care¹, J B Reitsma, clinical epidemiologist³, K G M Moons, professor of clinical epidemiology ¹

¹ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands, ² Kitasato Clinical Research Center, Kitasato University, Japan, ³ Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands

Correspondence to: G J Geersing g.j.geersing{at}umcutrecht.nl

Objective To review the evidence on the diagnostic accuracyof the currently available point of care D-dimer tests for excludingvenous thromboembolism.

Design Systematic review of research on the accuracy of pointof care D-dimer tests, using bivariate regression to examinesources of variation and to estimate sensitivity and specificity.

Data sources Studies on the diagnostic accuracy of point ofcare D-dimer tests published between January 1995 and September2008 and available in either Medline or Embase.

Review methods The analysis included studies that compared pointof care D-dimer tests with predefined reference criteria forvenous thromboembolism, enrolled consecutive outpatients, andallowed for construction of a 2x2 table.

Results 23 studies (total number of patients 13 959, range inmean age 38-65 years, range of venous thromboembolism prevalence4-51%) were included in the meta-analysis. The studies reportedtwo qualitative point of care D-dimer tests (SimpliRED D-dimer(n=12) and Clearview Simplify D-dimer (n=7)) and two quantitativepoint of care D-dimer tests (Cardiac D-dimer (n=4) and TriageD-dimer (n=2)). Overall sensitivity ranged from 0.85 (95% confidenceinterval 0.78 to 0.90) to 0.96 (0.91 to 0.98) and overall specificityfrom 0.48 (0.33 to 0.62) to 0.74 (0.69 to 0.78). The two quantitativetests 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 informationand guide patient management, notably in low risk patients (thatis, those patients with a low score on a clinical decision rule).

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