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Jeffrey S. Ginsberg, MD; Clive Kearon, MB; James Douketis, MD; Alexander G. G. Turpie, MB; Patrick Brill-Edwards, MD; Pamela Stevens, RN; Akbar Panju, MD; Ameen Patel, MD; Mark Crowther, MD; Maureen Andrew, MD; M. Patricia Massicotte, MD; Jack Hirsh, MD; Jeffrey I. Weitz, MD

Arch Intern Med. 1997;157(10):1077-1081.

Abstract
Objective
To prospectively test the hypothesis that a diagnosis of deep vein thrombosis can be excluded in outpatients who present with clinical indications of deep vein thrombosis and whose results of D-dimer testing and impedance plethysmographic examination on the day of presentation are normal.

Design
Prospective cohort study.

Setting
Four university-affiliated hospitals.

Methods
Three hundred ninety-eight consecutive patients with clinical indications of deep vein thrombosis were included in the final analysis. All patients underwent an assessment of pretest probability, bedside D-dimer testing, and impedance plethysmographic examination. In most patients, if the results of D-dimer testing and impedance plethysmographic examination were negative for deep vein thrombosis, anticoagulants were withheld and patients were followed up for 3 months. If the results of one or both tests were abnormal, an examination using venous compression ultrasonography or phlebography was performed.

Results
In the majority of patients (69%), the results of D-dimer testing and impedance plethysmographic examination were normal. This combination had a negative predictive value of 98.5% (95% confidence interval, 96.3-99.6) for deep vein thrombosis.

Conclusion
The results of the D-dimer assay and impedance plethysmographic examination on the day of presentation can be used to treat the majority of outpatients who present with clinical indications of deep vein thrombosis without further testing.

Arch Intern Med. 1997;157:1077-1081

Author Affiliations
From the Departments of Medicine (Drs Ginsberg, Kearon, Douketis, Turpie, Brill-Edwards, Panju, Patel, Crowther, Hirsh, and Weitz and Ms Stevens) and Pediatrics (Drs Andrew and Massicotte), McMaster University, Hamilton, Ontario.

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