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J Thromb Haemost. 2020 Mar;18(3):669-675. doi: 10.1111/jth.14718. Epub 2020 Jan 14.

Clinical pre-test probability adjusted versus age-adjusted D-dimer interpretation strategy for DVT diagnosis: A diagnostic individual patient data meta-analysis.

Author information

1
Department of Oncology, McMaster University, Hamilton, ON, Canada.
2
Department of Health Research Methods, Evidence, and Impact, Hamilton, ON, Canada.
3
Department of Medicine, University of Alberta, Edmonton, AB, Canada.
4
Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands.
5
Department of Emergency Medicine, Lund University Hospital, Lund University, Lund, Sweden.
6
Department of Medicine, McMaster University, Hamilton, ON, Canada.
7
Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada.

Abstract

BACKGROUND:

To increase the clinical usefulness of the D-dimer test in diagnosis of deep vein thrombosis (DVT), two strategies have been proposed: the age-adjusted, and the clinical pre-test probability (CPTP) adjusted interpretation. However, it is not known which of these strategies is superior.

OBJECTIVE:

To conduct an individual patient data (IPD) meta-analysis that compares the sensitivity, specificity, negative predictive value (NPV), and utility (the proportion of all patients who have a negative D-dimer test) when the two strategies are used to interpret D-dimer results.

METHODS:

Using an established IPD database, we conducted a meta-analysis to compare the two strategies. A bivariate random effects regression model was used to estimate and compare the pooled sensitivity and specificity simultaneously. The pooled NPV and utility of the two strategies was compared using a univariate random effects model.

RESULTS:

Four studies were eligible for this analysis, with a total of 2554 patients. Overall prevalence of DVT was 12% with substantial heterogeneity between studies (P value < .001). Both strategies have high pooled NPVs (99.8%) with a difference of 0% (95% confidence interval [CI]: -0.1, 0.1). The difference between the pooled specificity of the CPTP-adjusted strategy (57.3%) and the age-adjusted strategy (54.7%) was 2.6% (95% CI: -7.7, 12.8). The CPTP-adjusted strategy (49.4%) has a marginally greater pooled utility compared with the age-adjusted approach (47.4%), with a pooled difference of 1.9% (95% CI: -0.1, 3.9).

CONCLUSIONS:

Both D-dimer interpretation strategies were associated with a high and similar NPV, and similar utility.

KEYWORDS:

D-dimer; clinical pre-test probability; deep vein thrombosis; diagnosis; meta-analysis

PMID:
31869505
DOI:
10.1111/jth.14718

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