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Can D-dimer testing help emergency department physicians to detect acute aortic dissections? [Anatol J Cardiol]
Anatol J Cardiol. 2010; 10(5): 434-439 | DOI: 10.5152/akd.2010.142  

Can D-dimer testing help emergency department physicians to detect acute aortic dissections?

Murat Ersel1, Ersin Aksay2, Selahattin Kıyan1, Selen Bayraktaroğlu3, Aslıhan Yürüktümen1, Murat Özsaraç1, Tanzer Çalkavur4
1Department of Emergency Medicine, Faculty of Medicine, Ege University, İzmir, Turkey
2Department of Emergency Medicine, School of Medicine, Ege University, İzmir
3Ege Üniversitesi Tıp Fakültesi Radyoloji Anabilim Dalı, İzmir, Türkiye
4Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, İzmir, Turkey

Objective: To determine the diagnostic accuracy of D-dimer testing for detection of acute aortic dissection. Methods: This study is a retrospective chart review of patients who had been evaluated with suspicion of acute aortic dissection. All patients’ D-dimer levels were determined prior to their further work up in the emergency department. The study was conducted in a tertiary care center between February 2006-August 2008. The D-dimer assay used was the immunoturbidimetric assay, with a normal range up to 0.246 µg/ml. Statistical analysis was accomplished using Chi-square test, Student’s t-test and a receiver-operating characteristics (ROC) curve analysis. Results: Ninety-nine patients were included in the study, 30 patients were diagnosed as having acute aortic dissection and 69 patients were evaluated in non-acute aortic dissection group. In comparison of the two groups, positive D-dimer results were found to be significantly higher in acute aortic dissection group than in non-acute aortic dissection group (p<0.001). Sensitivity of the D-dimer test in detection of acute aortic dissection was found as 96.6% and the negative predictive value of the test was 97.3%. Specificity and positive predictive value of the D-dimer test were 52.2% and 46.8%, respectively. The area under the ROC curve yielded an acceptable certainty for excluding acute aortic dissection on base of negative results (AUC: 0.764; CI 95%: 0.674-0.855; p<0.001). Conclusion: D-dimer testing is helpful for emergency physicians in detection of patients with suspected acute aortic dissection in the emergency department.

Keywords: Acute aortic dissection, D-dimer, fibrin degradation products, emergency department, diagnostic value of tests

Murat Ersel, Ersin Aksay, Selahattin Kıyan, Selen Bayraktaroğlu, Aslıhan Yürüktümen, Murat Özsaraç, Tanzer Çalkavur. Can D-dimer testing help emergency department physicians to detect acute aortic dissections?. Anatol J Cardiol. 2010; 10(5): 434-439

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