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SimpliRed and diagnosis of deep venous thrombosis
  1. Steve Jones,
  2. Magnus Harrison
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M139WL, UK

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    Report by Steve Jones, Clinical Research Fellow Search checked by Magnus Harrison, Clinical Research Fellow

    Clinical scenario

    A patient attends the emergency department with signs and symptoms consistent with a deep venous thrombosis. Somebody suggests that there is a new bedside blood test, called SimpliRed, that may help to rule out the diagnosis in your patient. You know that ruling out a diagnosis is possible by having a test with a high sensitivity or negative predictive value. You wonder what evidence there is to suggest that SimpliRed fulfils these criteria?

    Three part question

    In a [patient with a suspected DVT] does the [SimpliRed test] reliably [rule out the diagnosis]?

    Search strategy

    Medline 1966–11/00 using the OVID interface. [(exp thrombosis or exp venous thrombosis or thrombosis.mp OR venous thrombosis.mp deep venous thrombosis.mp) AND (exp fibrin fibrinogen degradation products or simplired.mp OR d-dimer$.mp)] LIMIT to human and english language OR Medline 1966–11/00 using the OVID interface. simplired.mp.

    Search outcome

    Altogether 741 and 37 papers found of which 13 were relevant and of sufficient quality. These 13 remaining papers are shown in table 6.

    Table 6

    Comments

    The “gold standard” investigation for DVT is contrast venography. This has now been replaced in many centres with a strategy of single or serial compression ultrasound, hence the use of different reference standard tests.

    If an investigation is to be used in order to rule out a diagnosis, then it must have a sensitivity of 95% or above. In some of the studies mentioned this is the case, however such is the variability of the results obtained in the other studies the safety of SimpliRed as a lone exclusionary test must be in question. The reasons for this variability may include the operators of the assay or the various techniques used. Many of the results however are still inadequate.

    Clinical bottom line

    It is not safe to use SimpliRed as a lone exclusionary test for a patient presenting to the emergency department with a possible DVT.

    Report by Steve Jones, Clinical Research Fellow Search checked by Magnus Harrison, Clinical Research Fellow

    References

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