Limitations of D-dimer testing in unselected inpatients with suspected XXXX .

@entity1 @entity32 @entity5 @entity1151 @entity1150 @entity715 @entity1211 @entity1851
PURPOSE: To determine the utility and limitations of D-dimer testing for the evaluation of @entity1211 in hospitalized @entity1 . METHODS: We performed D-dimer testing by four different methods in unselected inpatients undergoing radiologic evaluation for possible @entity1211 . We included @entity1 with a history of @entity5 , recent surgery, @entity715 , and anticoagulation treatment. @entity1851 levels were assayed as a measure of @entity32 . RESULTS: Of 45 @entity1 with radiographically proven proximal @entity1150 or @entity1151 , 43 had elevated D-dimer levels by enzyme-linked immunosorbent assay (ELISA) (sensitivity, 96%); the specificity of the test was 23% (36/157). The qualitative non-ELISA tests had higher specificities, but their sensitivities were <70%. Nineteen @entity1 (42%) with @entity715 had false-negative D-dimer tests by at least one assay. The specificity of the tests decreased with increasing duration of hospitalization, increasing age, and increasing @entity1851 levels. D-dimer testing had little or no utility in distinguishing @entity1 with @entity715 from those without in @entity1 who had been hospitalized for more than 3 days, were older than 60 years, or had @entity1851 levels in the highest quartile. CONCLUSION: In unselected inpatients, D-dimer testing has limited clinical utility because of its poor specificity. This is particularly true for older @entity1 , those who have undergone prolonged hospitalization, and those with markedly elevated @entity1851 levels. In some @entity1 subsets, a negative non-ELISA D-dimer test cannot discriminate between inpatients with and without @entity715 .
