Description of Urban Emergency Department Patients with Elevated D-Dimer Levels

Retrospective chart review on patients who received a D-dimer test while being treated in the emergency department (ED) at Sinai-Grace Hospital (SGH), Harper University Hospital (HUH), and Detroit Receiving Hospital (DRH) over a five-Year period (2011-2016). D-dimer is a fibrin degradation product found in patient blood after a blood clot is degraded by fibrinolysis. It is used clinically to detect the presence of blood clots in a patient, typically to screen patients for deep vein thrombosis (DVT) and pulmonary embolism (PE). Although it is a sensitive screening tool, it is not specific to DVT or PE, and therefore leads to many unnecessary CT scans and other diagnostics / treatments that could be avoided if a better way of utilizing this blood test can be identified.

The purpose of the project is to characterize the patients who received a D-dimer screening test during their workup in the ED, as a first step towards identifying factors that may help providers to predict when a “false positive” D-dimer result is likely. Currently defined decision aids (e.g., Well’s Criteria, PERC Criteria) may not be adequate. This study will look at a largely African-American population (in Detroit), and therefore may find differing characteristics in our population than that seen with other large studies. It is believed that this kind of information could be helpful to ED physicians who are considering ordering a D-dimer as a screening tool for their ED patient. The student will participate in data collection including chart review.

Candidates for this position should have an interest in medicine, and be willing to learn about the medical management of patients who are treated in the ED. Work can be done "off-line," during the student's free time, with occasional scheduled meetings with team members. Must complete specific research training modules online prior to starting work on the project, which will be provided by our research team. Must contact Dr. Paxton at least 2 months in advance of anticipated start date in order to complete all paperwork for the IRB approval and basic research skills training.

2017-2018 academic year, although start date will be up to the individual student.

Student researcher will collaborate with other research staff to review patient charts and collect data pertaining to the patient's management in the ED, focusing primarily on the diagnosis and management of the patient. This will require access to the electronic medical record, which will be facilitated by the research staff. Students are expected to safeguard patient privacy and will be fully trained in basic research skills and how to review charts by members of the research team.

January 24, 2018