The utility of routine D-dimer measurement in syncope

Camilla J. Stockley, Matthew J. Reed, David E. Newby, Andrew J. Coull, Gareth R. Clegg, Alasdair J. Gray

Research output: Contribution to journalArticlepeer-review

Abstract

Aim To establish whether D-dimer is an independent predictor of 1-month serious outcome and all-cause death in syncope patients presenting to the emergency department (ED).

Methods This was a prospective cohort study of all adults presenting with syncope to an ED in the UK. Plasma D-dimer concentrations were determined in citrated plasma obtained at presentation. The primary endpoint was the combination of serious outcome and all-cause death at 1 month.

Results Of 237 patients enrolled, 205 patients had a suitable plasma sample and had complete follow-up. Seventeen patients had a serious outcome or death at 1 month including three patients with a pulmonary embolus and eight with a serious cardiovascular outcome. Nearly a half of all patients (n=94; 46%) had a plasma D-dimer concentration above the upper limit of normal, 10 of whom had a serious outcome or death at 1 month. Receiver-operator characteristic curve analysis showed no relationship between plasma D-dimer concentration and serious outcome or death at 1 month. An elevated plasma D-dimer concentration was found in all patients with a pulmonary embolus.

Conclusion Plasma D-dimer is frequently raised in patients presenting with syncope to the ED and consequently does not predict 1-month serious outcome or death. We conclude that there is no role for the routine measurement of D-dimer in the management of patients presenting to the ED with syncope. European Journal of Emergency Medicine 16:256-260 (c) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

Original languageEnglish
Pages (from-to)256-260
Number of pages5
JournalEuropean journal of emergency medicine : official journal of the European Society for Emergency Medicine
Volume16
Issue number5
DOIs
Publication statusPublished - Oct 2009

Keywords

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Emergency Service, Hospital
  • Female
  • Fibrin Fibrinogen Degradation Products
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Pulmonary Embolism
  • ROC Curve
  • Syncope
  • Young Adult
  • Evaluation Studies
  • Journal Article

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