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RESEARCH: G J Geersing, K J M Janssen, R Oudega, L Bax, A W Hoes, J B Reitsma, and K G M Moons Excluding venous thromboembolism using point of care D-dimer tests in outpatients: a diagnostic meta-analysis BMJ 2009; 339: b2990 [Abstract] [Full text]

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True D-dimer point of care test implications

Amit Patel   (26 August 2009)

True D-dimer point of care test implications 26 August 2009
Amit Patel, NIHR Academic Clinical Fellow Dept. of Haematology, Imperial College London, Hammersmith Hospital, Du Cane Rd, London, W12 0NN Send response to journal: Re: True D-dimer point of care test implications	I read the D-dimer point of care test (POCT) meta-analysis[1] on excluding venous thromboembolism with interest. Despite the advantages described, including reduced time and improved accuracy, interpretation still requires an appropriate clinical risk assessment. As emergency departments in the UK are often served by supervised but very junior doctors, this may be variable and difficult despite an appropriate local protocol. In the primary care setting where more experienced doctors maybe assessing patients, without nearby laboratory support, POCT costs are not to be underestimated. Healthcare environments wishing to invest in a d-dimer POCT should consult the recent British Society for Haematology Guidelines.[2] Erroneous errors by POCT may result in raised insurance premiums and litigation, particularly if sufficient internal quality control and external quality assurance cannot be demonstrated. A local responsible person should take this role, along with that for complete audit and record keeping, as well as personnel competency training. Storage and supply of reagents, servicing and maintenance are also significant costs. Primary care providers, who the authors[1] suggest as a major beneficiary of d-dimer POCT, should consider these issues when comparing the cost of referral for imaging or secondary care opinion. References [1] Geersing GJ, Janssen KJ, Oudega R, Bax L, Hoes AW, Reitsma JB, Moons KG. Excluding venous thromboembolism using point of care D-dimer tests in outpatients: a diagnostic meta-analysis. BMJ. 2009;339:b2990. [2] Briggs C, Guthrie D, Hyde K, Mackie I, Parker N, Popek M, Porter N, Stephens C; British Committee for Standards in Haematology General Haematology Task Force. Guidelines for point-of-care testing: haematology. Br J Haematol. 2008;142:904-15. Competing interests: None declared