Great read from the PEM Playbook by Tim Horezko at the Pediatric Emergency Playbook. The bottom line is that he asserts that D-dimer should have limited utility in the diagnostic workup of pulmonary emboli in children who almost always have a reason for a PE like malignancy, prior DVT etc,. In fact, 98% of kids with PE have at least one identifiable risk factor, most with two. He notes that,

“The only data we have in using d-dimer in children is to prognosticate in established cases. It is only helpful to track therapy for children who have chronic clots. This is where our adult approach can get us into trouble. Basically, think of the d-dimer in children like it doesn’t even exist. It’s not helpful in our setting for our indications.”

He goes on to state that,

“Up to a third of adults with

[idiopathic] PE have no known risk factor, which makes decision tools and risk stratification important in this population.”

In short, if you think a kid has a DVT-  get an ultrasound. If you think they might have a PE and you need to rule it out don’t use the D-dimer as it has not been adequately studied. Instead, go straight to imaging like a CT angiogram or VQ scan.

Read more from Tim at the excellent Pediatric Emergency Playbook.