Most of the recent systematic reviews seem to be hiding in fairly obscure
journals at present (although there's a few systematic reviews assessed on
the NHS CRD site (can be accessed via Cochrane database, and probably via
NELH- EC). I'd reckon that the emedicine article is a bit pessimistic
though. A repeated issue in systematic reviews is the question of
comparators. If you take angiography (or spiral CT) as the gold standard,
then d- dimers miss a few PEs, but that doesn't mean that you should be
treating the ones it misses- the risk/ benefit calculation is probably very
different. A negative d- dimer is probably a pretty sensitive test for
excluding active ongoing intravascular coagulation of any sort (as opposed
to old, organised thrombi or emboli).
Matt Dunn
Warwick
> Robert Spykerman
> CUH ED
BTW, what's a CUH ED?
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