BET 1: Does a normal D-dimer rule out cerebral venous sinus thrombosis (CVST)?

Jean-Francois Hibbert recommends Clinical scenario

A 32-year-old woman presented to the emergency department (ED) with a history of occipital headache and intermittent blurred vision for the past 3 weeks. D-dimer performed on admission is within normal range. Can you safely rule out cerebral venous sinus thrombosis (CVST)?

Three-part question

In (patients presenting to and ED with suspected CVST) does a (normal D-dimer) rule out this condition?

Search strategy

NICE Healthcare interface Medline 1966–November 2016

[ddimer.ti,ab] AND [exp INTRACRANIAL EMBOLISM/OR exp INTRACRANIAL THROMBOSIS/OR exp SINUS THROMBOSIS, INTRACRANIAL/OR exp CAVERNOUS SINUS THROMBOSIS/OR exp INTRACRANIAL EMBOLISM AND THROMBOSIS/OR exp LATERAL SINUS THROMBOSIS/OR exp SAGITTAL SINUS THROMBOSIS/OR (cerebral AND venous AND sinus AND thrombosis).ti,ab/OR (sinus AND thrombosis).ti,ab] AND [exp DIAGNOSIS/OR (rule AND out).ti,ab/OR exclu*.ti,ab/OR normal.ti,ab/OR negative.ti,ab/OR sensitivity.ti,ab/OR diagnosis.ti,ab]

Search outcome

Seventy-one papers were identified, of which 52 were irrelevant and 7 were of insufficient quality for inclusion.

Twelve papers were included for use in final review. This included two systematic reviews that…

from Emergency Medicine Journal Best evidence topic reports


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