Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
To the Editor: In their article on the diagnostic characteristics of D-dimer assay and alveolar dead-space measurement (ADSM) for rapid exclusion of pulmonary embolism (PE), Dr Kline and colleagues1 conclude that this diagnostic strategy "could have obviated pulmonary vascular imaging [PVI] in 43% of hemodynamically stable ED [emergency department] patients with suspected PE." This would only be true if ED physicians ordered this combined test with the same frequency that they now order PVI tests. D-dimer assay and ADSM were only evaluated in patients for whom the decision had been made to order PVI. Kline and colleagues mention that current diagnostic tests for PE, that is, PVI, "often require hours to perform, add substantial cost to the evaluation, and expose the patient to ionizing radiation. Moreover, pulmonary vascular imaging tests may not be available quickly 24 hours per day in many facilities." In contrast, D-dimer assay and ADSM could be available around the clock, are inexpensive, and are noninvasive.
Schuur J. Bedside Diagnostic Tests for Pulmonary Embolism. JAMA. 2001;285(18):2326-2327. doi:10.1001/jama.285.18.2326