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Titolo:
D-dimer testing as the initial test for suspected pulmonary embolism. Appropriateness of prescription and physician compliance to guidelines
Autore:
Durieux, P; Dhote, R; Meyniard, O; Spaulding, C; Luchon, L; Toulon, P;
Indirizzi:
Hop Cochin, Serv Med Interne, F-75014 Paris, France Hop Cochin Paris France F-75014 Serv Med Interne, F-75014 Paris, France Hop Cochin, Serv Sante Publ, F-75674 Paris, France Hop Cochin Paris France F-75674 , Serv Sante Publ, F-75674 Paris, France Hop Cochin, Serv Pneumol, F-75674 Paris, France Hop Cochin Paris France F-75674 hin, Serv Pneumol, F-75674 Paris, France Hop Cochin, Serv Cardiol, F-75674 Paris, France Hop Cochin Paris France F-75674 hin, Serv Cardiol, F-75674 Paris, France Hop Cochin, Hematol Lab, F-75674 Paris, France Hop Cochin Paris France F-75674 chin, Hematol Lab, F-75674 Paris, France
Titolo Testata:
THROMBOSIS RESEARCH
fascicolo: 4, volume: 101, anno: 2001,
pagine: 261 - 266
SICI:
0049-3848(20010215)101:4<261:DTATIT>2.0.ZU;2-F
Fonte:
ISI
Lingua:
ENG
Soggetto:
COST-EFFECTIVENESS ANALYSIS; VENOUS THROMBOEMBOLISM; HOSPITALIZED-PATIENTS; SPIRAL CT; MANAGEMENT; DIAGNOSIS; ELISA; STRATEGIES; DECISION;
Keywords:
deep venous thrombosis; D-dimer testing; physician's practice patterns;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Life Sciences
Citazioni:
23
Recensione:
Indirizzi per estratti:
Indirizzo: Dhote, R Hop Cochin, Serv Med Interne, 27 Rue Faubourg St Jacques, F-75014Paris, France Hop Cochin 27 Rue Faubourg St Jacques Paris France F-75014 rance
Citazione:
P. Durieux et al., "D-dimer testing as the initial test for suspected pulmonary embolism. Appropriateness of prescription and physician compliance to guidelines", THROMB RES, 101(4), 2001, pp. 261-266

Abstract

Objectives: Recent studies have shown that strategies for pulmonary embolism diagnosis which have included D-dimer testing have been most cost effective. The objective of this study is to evaluate the impact of implementation of a new strategy for pulmonary embolism diagnosis based on D-dimer results. Methods: A prospective survey was conducted in the emergency ward and three medical departments of a university teaching hospital. Guidelines for diagnosis of PE were established and implemented through an educational intervention and a specific order form. D-dimer (ELISA) was required for all patients suspected of having PE. A result above 500 ng/ml was to be followedby a pulmonary imaging procedure. Appropriateness of prescription of D-dimer and non-compliance with guidelines (absence of diagnostic imaging procedure following D-dimer results above 500 ng/ml) were evaluated. Results: One-hundred sixty patients were studied. D-dimer test was performed in 154 patients (96.3%) suspected of PE during a two-month period. Tests results wereabove 500 ng/ml in 111 cases. PE was confirmed in 20 cases. Twenty percent(31/154) of the D-dimer prescriptions were inappropriate. Among those withD-dimer results above 500 ng/ml, 45% (50/111) of the patients experienced no imaging procedure. Conclusion: Despite implementation of clinical guidelines for its use, D-dimer was excessively prescribed. A large proportion ofresults was not taken in consideration by prescribers. Often new technologies have good experimental results, but behave differently when used routinely in ordinary care settings. It is important that field studies be developed to evaluate the effectiveness of new technologies. (C) 2001 Elsevier Science Ltd. All rights reserved.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 20/01/21 alle ore 12:27:09