Sameer Parpia1,2, Sarah Takach Lapner3, Roger Schutgens4, Johan Elf5, Geert-Jan Geersing4, Clive Kearon6,7. 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.
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.
Authors: Synne G Fronas; Camilla T Jørgensen; Anders E A Dahm; Hilde S Wik; Jostein Gleditsch; Nezar Raouf; René Holst; F A Klok; Waleed Ghanima Journal: Blood Adv Date: 2020-10-27