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The D-dimer is only useful in the negative direction; a negative D-dimer means the patient probably doesn't need a scan, especially if put together with the Wells criteria. True, there are plenty of false-positive D-dimers, but if it saves you coming in at 3:00 a.m. for a silly scan, what the hey. If there is a positive D-dimer, then at least the doc made an effort, especially if symptoms were considered carefully. I don't mind doing a wee-hours scan if it really seems like a good idea. (I should use the past tense—not "don't" but "didn't"—I haven't done call for a couple of years.)

We've had (intermittent) good luck in the ER with implementation of Wells plus D-dimer. Our usual positive rate over the years has hovered at or below 10%, but I believe that's improved now.

Don Ridgway





-----Original Message-----
From: UVM Flownet on behalf of Kimberly Higgins
Sent: Mon 3/19/2012 9:48 AM
To: [log in to unmask]
Subject: Re: ER positives
 
Wow, I just cannot understand how this is the norm. Do any EDs use standing order sets or use the Wells Criteria before ordering a DVT study? Our ED does not and admit it's based individually. Many patients are sent from their primary physician and the patient is expecting a doppler study. I am also leery of the D-Dimer test. Of course, it's great when it's negative, but I wonder how many actually are? It seems there are way too many false positives to use this as a screening tool?

________________________________
From: UVM Flownet [[log in to unmask]] On Behalf Of [log in to unmask] [[log in to unmask]]
Sent: Monday, March 19, 2012 11:45 AM
To: [log in to unmask]
Subject: Re: ER positives

Interesting, but, consistent results.  My last place of employment averaged 12 to 16%.  We monitored it quarterly.

Sent from my Verizon Wireless Phone

----- Reply message -----
From: "Schneider, Joseph MD" <[log in to unmask]>
To: <[log in to unmask]>
Subject: ER positives
Date: Mon, Mar 19, 2012 9:54 am


We were at 12% when we last checked at my last job, this is about what you expect for screening unless your institution commits to D-dimer as a first test

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Kimberly Higgins
Sent: Monday, March 19, 2012 7:11 AM
To: [log in to unmask]
Subject: ER positives

Happy Monday to you all! :)

Just have a question for you regarding your percent of positive DVT studies coming out of the ER when the sonographer is on-call. We have been tracking our outcomes for the past year and have realized that only 10% (YTD average) are positive. This number only includes our after hour call in studies. (I'm sure this number would be worse if we included ALL ER patients.) Do any of you track the number of positive studies from the ER during on-call hours? We have no benchmark as we dont know what the standard is or what it even should be? Of course, we would LIKE the benchmark to be at 100%, but I just wonder what the "actual" is across the states. Are we completely off or is this just the standard "CYA" all over the nation?

Any help is greatly appreciated!



Kim Higgins, BS, RDMS, RVT
Vascular Lab Technical Director
Licking Memorial Health Systems
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This e-mail, including attachments, is intended for the sole use of the individual and/or entity to whom it is addressed, and contains information from Licking Memorial Health Systems which is confidential or privileged. If you are not the intended recipient, nor authorized to receive for the intended recipient, be aware that any disclosure, copying, distribution or use of the contents of this e-mail and attachments is prohibited. If you have received this in error, please advise the sender by reply e-mail and delete the message immediately. You may also contact the LMH Process Improvement Center at 740-348-4641. E-mail transmissions cannot be guaranteed to be secure or error-free as information could be intercepted, corrupted, lost, destroyed, arrive late or incomplete, or contain viruses. The sender therefore does not accept liability for any errors or omissions in the contents of this message, which arise as a result of e-mail transmission. Thank you.

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