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

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2990 (Published 14 August 2009) Cite this as: BMJ 2009;339:b2990

Rapid Response:

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

Competing interests: No competing interests

26 August 2009
Amit Patel
NIHR Academic Clinical Fellow
Dept. of Haematology, Imperial College London, Hammersmith Hospital, Du Cane Rd, London, W12 0NN