Serum D-dimer level as a biomarker for identifying patients with isolated injury to prevent unnecessary whole-body computed tomography in blunt trauma care.
Blunt trauma
Computed tomography
D-dimer
Multiple trauma
Radiation exposure
Whole-body CT
Journal
Scandinavian journal of trauma, resuscitation and emergency medicine
ISSN: 1757-7241
Titre abrégé: Scand J Trauma Resusc Emerg Med
Pays: England
ID NLM: 101477511
Informations de publication
Date de publication:
07 Jan 2021
07 Jan 2021
Historique:
received:
21
08
2020
accepted:
24
11
2020
entrez:
8
1
2021
pubmed:
9
1
2021
medline:
18
5
2021
Statut:
epublish
Résumé
Unnecessary whole-body computed tomography (CT) may lead to excess radiation exposure. Serum D-dimer levels have been reported to correlate with injury severity. We examined the predictive value of serum D-dimer level for identifying patients with isolated injury that can be diagnosed with selected-region CT rather than whole-body CT. This single-center retrospective cohort study included patients with blunt trauma (2014-2017). We included patients whose serum D-dimer levels were measured before they underwent whole-body CT. "Isolated" injury was defined as injury with Abbreviated Injury Scale (AIS) score ≤ 5 to any of five regions of interest or with AIS score ≤ 1 to other regions, as revealed by a CT scan. A receiver operating characteristic curve (ROC) was drawn for D-dimer levels corresponding to isolated injury; the area under the ROC (AUROC) was evaluated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for several candidate cut-off values for serum D-dimer levels. Isolated injury was detected in 212 patients. AUROC was 0.861 (95% confidence interval [CI]: 0.815-0.907) for isolated injury prediction. Serum D-dimer level ≤ 2.5 μg/mL was an optimal cutoff value for predicting isolated injury with high specificity (100.0%) and positive predictive value (100.0%). Approximately 30% of patients had serum D-dimer levels below this cutoff value. D-dimer level ≤ 2.5 μg/mL had high specificity and high positive predictive value in cases of isolated injury, which could be diagnosed with selected-region CT, reducing exposure to radiation associated with whole-body CT.
Sections du résumé
BACKGROUND
BACKGROUND
Unnecessary whole-body computed tomography (CT) may lead to excess radiation exposure. Serum D-dimer levels have been reported to correlate with injury severity. We examined the predictive value of serum D-dimer level for identifying patients with isolated injury that can be diagnosed with selected-region CT rather than whole-body CT.
METHODS
METHODS
This single-center retrospective cohort study included patients with blunt trauma (2014-2017). We included patients whose serum D-dimer levels were measured before they underwent whole-body CT. "Isolated" injury was defined as injury with Abbreviated Injury Scale (AIS) score ≤ 5 to any of five regions of interest or with AIS score ≤ 1 to other regions, as revealed by a CT scan. A receiver operating characteristic curve (ROC) was drawn for D-dimer levels corresponding to isolated injury; the area under the ROC (AUROC) was evaluated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for several candidate cut-off values for serum D-dimer levels.
RESULTS
RESULTS
Isolated injury was detected in 212 patients. AUROC was 0.861 (95% confidence interval [CI]: 0.815-0.907) for isolated injury prediction. Serum D-dimer level ≤ 2.5 μg/mL was an optimal cutoff value for predicting isolated injury with high specificity (100.0%) and positive predictive value (100.0%). Approximately 30% of patients had serum D-dimer levels below this cutoff value.
CONCLUSION
CONCLUSIONS
D-dimer level ≤ 2.5 μg/mL had high specificity and high positive predictive value in cases of isolated injury, which could be diagnosed with selected-region CT, reducing exposure to radiation associated with whole-body CT.
Identifiants
pubmed: 33413585
doi: 10.1186/s13049-020-00815-9
pii: 10.1186/s13049-020-00815-9
pmc: PMC7789640
doi:
Substances chimiques
Biomarkers
0
Fibrin Fibrinogen Degradation Products
0
fibrin fragment D
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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