Original article. D-dimer assay not adequate for spontaneous intracranial hemorrhage screening

Background: Patients with signs/symptoms of spontaneous intracranial hemorrhage (SICH) in the emergency department (ED) generally undergo computed tomography (CT) scanning.

Objective: To assess whether D-dimer assay alone at ED admission can be used for screening non-traumatic patients with suspected ICH who do not have new onset of neurological deficits to reduce the number of CT scans.

Methods: The study included 90 non-traumatic patients who were admitted to the ED and had signs/symptoms suggestive of SICH but did not have new neurological deficits. All patients underwent non-contrast CT within 30 minutes. Three patients also underwent lumbar puncture for a definitive diagnosis. Blood D-dimer levels were measured from venous blood samples obtained in the ED. All patients were followed up for one year. The diagnosis at 3 months follow-up was used to determine whether CT was helpful.

Results: CT was not helpful for 60 patients and was necessary for 30 patients. Multivariate analysis showed that dizziness/vertigo, systolic blood pressure >120 mmHg, and positive D-dimer assay (>500 ng/ml) were significantly related to the need for CT. The results of multivariate analysis were used to perform area under the curve analysis to provide data on sensitivity, specificity, positive predictive value, and negative predictive value for these three independent factors that affect the need for CT examination. Further analysis showed that all seven patients with subarachnoid hemorrhage had a positive D-dimer assay and their median D-dimer level was significantly higher than that of patients with intracerebral hemorrhage or stroke.

Conclusions: D-dimer assay alone is inadequate in the ED for screening non-traumatic patients with suspected SICH who do not have new onset of neurological deficits to reduce the number of CT scans.