Skip to main content
  • Letter to the Editor
  • Open access
  • Published:

Comment on “The diagnostic value of D-dimer with simplified Geneva score (SGS) pre-test in the diagnosis of pulmonary embolism (PE)”

Abstract

Any decision in clinical practice needs to evaluate both reliability (precision) and validity (accuracy) of a diagnostic test. Without knowledge about the reliability, any judgment would be wrong. In diagnostic accuracy research, it is essential to evaluate the diagnostic added value of a test, since a diagnostic accuracy of a single test might be excellent, however for clinical purposes it can be worthless. Like evaluating discrimination, it would be possible to estimate the diagnostic added value by applying ROC of diagnostic model with and without test results in the model.

Peer Review reports

To the Editor.

I read the paper from Zhihui Fu et al. published in J Cardiothorac Surg [1]. The aim of the study was to assess the diagnostic value of D-dimer with simplified Geneva score (SGS) pre-test in the diagnosis of pulmonary embolism (PE). In a retrospective analysis, 1035 patients with suspected PE were recruited. All enrolled patients were grouped according to the computed tomographic pulmonary angiogram (CTPA) results: PE patients and non-PE patients. Then, receiver operating characteristic (ROC) curve were constructed to determine the optimal D-dimer cutoff point value which is based on Yonden’s index (YI).

Although I appreciate this significant study, I would like to raise some methodological issues that can affect the interpretation of results. First, any decision in clinical practice needs to evaluate both reliability (precision) and validity (accuracy) of CTPA. Without knowledge about the reliability, any judgment would be wrong [2,3,4,5,6]. Second, in diagnostic accuracy research, it is essential to evaluate the diagnostic added value of CTPA, since a diagnostic accuracy of a single test might be excellent, however for clinical purposes it can be worthless. Like evaluating discrimination, it would be possible to estimate the diagnostic added value by applying ROC of diagnostic model with and without CTPA [2, 7, 8]. Hence, we suggest the authors to estimate both diagnostic added value and reliability of the CTPA by an appropriate method.

Availability of data and materials

NA

Abbreviations

SGS:

Simplified Geneva Score

CTPA:

Computed Tomographic Pulmonary Angiogram

ROC:

Receiver Operating Characteristic

YI:

Yonden’s Index

References

  1. Zhihui F, Zhuang X, He Y, Huang H, Guo W. The diagnostic value of D-dimer with simplified Geneva score (SGS) pre-test in the diagnosis of pulmonary embolism (PE). J Cardiothorac Surg. 2020 Jul 20;15(1):176.

    Article  Google Scholar 

  2. Grobbee DE, Hoes AW. Clinical epidemiology: Jones & Bartlett Publishers; 2014.

  3. Sabour S. Reproducibility of dynamic Scheimpflug-based pneumotonometer and its correlation with a dynamic bidirectional pneumotonometry device: methodological issues. Cornea. 2015;34:14–5.

    Article  Google Scholar 

  4. Sabour S, Rutten A, van der Schouw YT, Atsma F, Grobbee DE, Mali WP, et al. Inter-scan reproducibility of coronary calcium measurement using multi detector-row computed tomography (MDCT). Eur J Epidemiol. 2007;22:235–43.

    Article  Google Scholar 

  5. Sabour S. Reproducibility of semi-automatic coronary plaque quantification in coronary CT angiography with sub-mSv radiation dose; common mistakes. J Cardiovasc Comput Tomogr. 2016;10:21–2.

    Article  Google Scholar 

  6. Naderi M, Sabour S. Reproducibility of diagnostic criteria associated with atypical breast cytology: a methodological issue. Cytopathology. 2018;29:396.

    Article  CAS  Google Scholar 

  7. Sabour S. A common mistake in assessing the diagnostic value of a test: failure to account for statistical and methodologic issues. J Nucl Med. 2017;58:1182–3.

    Article  Google Scholar 

  8. Sabour S, Ghassemi F. Accuracy, validity, and reliability of the infrared optical head tracker (IOHT). Invest Ophthalmol Vis Sci. 2012;53:4776.

    Article  Google Scholar 

Download references

Acknowledgements

NA

Funding

None.

Author information

Authors and Affiliations

Authors

Contributions

Conceptualization; Writing - Review & Editing; Methodology; Validation. The author(s) read and approved the final manuscript.

Corresponding author

Correspondence to Siamak Sabour.

Ethics declarations

Ethics approval and consent to participate

NA

Consent for publication

NA

Competing interests

None.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sabour, S. Comment on “The diagnostic value of D-dimer with simplified Geneva score (SGS) pre-test in the diagnosis of pulmonary embolism (PE)”. J Cardiothorac Surg 15, 246 (2020). https://doi.org/10.1186/s13019-020-01301-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13019-020-01301-0