Plasma D-dimer levels can provide useful diagnostic information on acute vertebral compression fractures in patients with low back pain in the emergency room

Background Patients with acute vertebral compression fractures (aVCFs) are frequently transferred to an emergency room (ER) by ambulance. The most useful imaging modality is magnetic resonance (MR) imaging; however, which patients should be prioritized for MR study may be unclear. The aim of this study was to evaluate plasma D-dimer levels as a biomarker for aVCFs. Methods This was a retrospective cohort study that included patients with low back pain in the ER between November 2017 and October 2020. The patients who were diagnosed with infections, coagulation disorders, and without D-dimer levels measurements were excluded. The presence of an aVCF was diagnosed with MR imaging. Blood samples were collected for routine blood tests. The predictive factors for aVCFs were evaluated with univariate and multivariable logistic regression analyses. Results Overall, 191 consecutive MR imaging evaluations were ordered. After the exclusion, 101 patients were reviewed. Based on MR, 65 (64.4%) cases were diagnosed with aVCFs. The presence of aVCFs was significantly correlated with age (OR 1.052, 95% CI 1.018 - 1.191), an old VCF (OR 3.290, 95% CI 1.342 - 8.075), hemoglobin (OR 0.699, 95% CI 0.535 - 0.912), and D-dimer levels (OR 1.829, 95% CI 1.260 - 2.656). Results from a multivariable logistic regression analysis, showed D-dimer levels (OR 1.642, 95% CI 1.188 - 2.228) remained a significant risk factor for the presence of aVCFs after adjustment for potential confounders. Conclusion Plasma D-dimer levels can provide useful diagnostic information on whether an aVCF is present.