I had thought
that a D-dimer should not be requested on a patient with a clinical
scoring of 3 or more as this was a high risk group for DVT. The patient should
instead have a doppler etc. A normal D-dimer test in a high risk group
would not be a 100% reassuring.
Absolutely agree with you - I've just had a barney with a medical SHO
last night regarding this exact point. Many people question the content and
quality of current A&E training in this country, but critical appraisal
and a cursory understanding of stats is probably one of the FFAEM's successes.
I think this often leaves us in a situation now of having a better
understanding than many other practitioners of the value of a test, and
the fact that tests alter probabilities rather than giving"Yes/No" answers.
Once other specialties catch up, I wonder whether we'll face quite the same
problems.
Chris Biggin
North Tyneside
I had thought that a D-dimer should not be
requested on a patient with a clinical scoring of 3 or more as this was a
high risk group for DVT. The patient should instead have a doppler
etc. A normal D-dimer test in a high risk group would not be a 100%
reassuring.
However a trend has developed locally for all
patients to need a D-dimer before any further investigation. So a Doppler
may be refused even if the patient obviously has a DVT. e.g. drug addict
injecting into groin with leg twice normal size.
What is happening in other
hospitals?
Ray McGlone
A&E Consultant
Royal Lancaster Infirmary
/ Westmorland General Hospital
