PROSPECTIVE DETERMINATION OF FIBRIN DEGRA DATION PRODUCT D-DIMER IN THE DIAGNOSIS OF PULMONARY-EMBOLISM (PE)

Pulmonary embolism (PE) is still misdiagnosed in a high proportion of cases. 107 patients admitted for suspected pulmonary embolism were stu died prospectively to shed light on the value of ELISA-D-dimer and Lat ex-D-dimer. Pulmonary embolism was ruled out by negative perfusion sca ns in 66 patients (61.7%) and by angiography in 24 patients. 58% of th e scans suggesting a high probability of PE were confirmed by angiogra phy, but only 18% of the scans suggesting a low or intermediate probab ility of PE. Sensitivity and specificity were 88% and 79%, respectivel y for the D-dimer ELISA, versus 94% and 90% for the Latex agglutinatio n test. The Latex test increased the positive predictive value of lung scanning suggesting low to intermediate probability of PE (group B) f rom 18% to 75% and that of lung scanning suggesting high probability o f PE (group C) from 58% to 93%. The positive predictive value was impr oved by ELISA-D-dimer in both groups to 75%. In order to augment the d iagnostic efficacy in clinical practice the determination of Latex-D-d imer simultaneously with lung scanning is recommended.