> --- Ray McGlone <[log in to unmask]> wrote:
> > 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.
> The problem with compression U/S is that it can miss
> short isolated femoral vein thrombosis and a -ve
> D-dimer does actually help you here.
>
> Cheers Fred.
And furthermore, the short femoral clot is exactly what the femoral injecting addict gets. I find all this hoop-jumping extremely
tedious and irritating. Look at John Hall's posting for an example. The test that determines with a pretty good sensitivity and
specificity what is going on is the Doppler ultrasound. That can provide a definite answer from below the trifurcation to the IVC.
However, because, as Fred says, it needs a radiologist, we have to do lots of 'screening' tests of dubious veracity such as D-dimer,
venometry and so on before they will deign to do the test. How did we let them get away with this? I don't do chest
plethysmography before asking for a CXR, for example.
Best wishes,
Rowley Cottingham
[log in to unmask]
http://www.emergencyunit.com
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