Clinical pre-test probability adjusted versus age-adjusted D-dimer interpretation strategy for DVT diagnosis : A diagnostic individual patient data meta-analysis
(2020) In Journal of Thrombosis and Haemostasis 18(3). p.669-675- 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... (More)
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.
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- author
- Parpia, Sameer ; Takach Lapner, Sarah ; Schutgens, Roger ; Elf, Johan LU ; Geersing, Geert Jan and Kearon, Clive
- organization
- publishing date
- 2020
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- clinical pre-test probability, D-dimer, deep vein thrombosis, diagnosis, meta-analysis
- in
- Journal of Thrombosis and Haemostasis
- volume
- 18
- issue
- 3
- pages
- 7 pages
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:85077864317
- pmid:31869505
- ISSN
- 1538-7933
- DOI
- 10.1111/jth.14718
- language
- English
- LU publication?
- yes
- id
- 5408bd53-25ae-4327-8c76-f79e727e82e0
- date added to LUP
- 2020-12-28 11:44:03
- date last changed
- 2024-05-30 02:25:04
@article{5408bd53-25ae-4327-8c76-f79e727e82e0,
abstract = {{<p>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.</p>}},
author = {{Parpia, Sameer and Takach Lapner, Sarah and Schutgens, Roger and Elf, Johan and Geersing, Geert Jan and Kearon, Clive}},
issn = {{1538-7933}},
keywords = {{clinical pre-test probability; D-dimer; deep vein thrombosis; diagnosis; meta-analysis}},
language = {{eng}},
number = {{3}},
pages = {{669--675}},
publisher = {{Wiley-Blackwell}},
series = {{Journal of Thrombosis and Haemostasis}},
title = {{Clinical pre-test probability adjusted versus age-adjusted D-dimer interpretation strategy for DVT diagnosis : A diagnostic individual patient data meta-analysis}},
url = {{http://dx.doi.org/10.1111/jth.14718}},
doi = {{10.1111/jth.14718}},
volume = {{18}},
year = {{2020}},
}