Age-Adjusted D-Dimer in the Prediction of Pulmonary Embolism: Does a Normal Age-Adjusted D-Dimer Rule Out PE?

Ortiz, Jacob; Saeed, Rabia; Little, Christopher; Schaefer, Saul

doi:10.1155/2017/4867060

Cited by 9 publications

(5 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[34][35][36] This is thought to increase the specificity of the D-dimer in the elderly. [37][38][39] Clinical studies indicate that the D-dimer values are slightly higher in women, which is in accordance with the results of this study. As was the case with the results of other researchers, the difference was not significant in the present study either.…”

Section: Discussionsupporting

confidence: 92%

D-dimer: A role in ruling out pulmonary embolism in an emergency care department

Hadžić¹,

Maksimović²,

Stajić³

et al. 2020

Scripta Medica

View full text Add to dashboard Cite

Background/Aim: Pulmonary embolism (PE) is a diagnostic challenge, particularly in prehospital care. The aim of this study was to determine to what extent the evaluation of D-dimer value helps physicians with differentiation of PE and whether D-dimer values are in correlation with the values of revised Geneva score. Methods: Data have been collected for the patients whose D-dimer has been evaluated at the Emergency Care Department of the City of Banja Luka in 2018. Gender, age, symptoms, working diagnosis and D-dimer value have all been recorded and also the fact whether the patient was referred to hospital treatment or not. For each patient the revised Geneva score was determined. Results: Sixty-eight tests were done in 2018. Out of 68 tests, 41 were negative (60.3 %). D-dimer results helped in making decisions about referring patients to the hospital or not (χ 2 = 36.32, p < 0.001). Patients with elevated D-dimer levels, especially where the values were four times higher than the refence ones typically were referred to hospital treatment, whereas 67.5% patients with negative D-dimer results were sent home after giving a treatment and advice. In the elderly patients D-dimer was statistically more positive (F = 10.82, p < 0.001). Values of D-dimer were not significantly different regarding gender (χ 2 = 2.19, p = 0.33). According to the results of the revised Geneva score, 5.1 % of patients had high risk of PTE, while moderate and low risk had 47.5 % each. Although it has been found that the values of D-dimer were slightly more elevated at higher values of the revised Geneva score and that the difference was not statistically significant (χ 2 = 7.71, p = 0.10). Conclusion: Values of D-dimer considerably helped in differentiation of PE in the Emergency Care Department. D-dimer has a high negative predictive value and should be used to exclude PE diagnosis for patients with low clinical probability of PE.Key words: D-dimer, pulmonary embolism, revised Geneva score, emergency care department.Pulmonary embolism (PE) is one of the most difficult conditions to diagnose, particularly in the prehospital care. It represents the most serious clinical manifestation of venous thromboembolism (VTE), which represents the third most common cardiovascular disease. [1][2][3][4] The main cause of PE-related deaths is the undiagnosed PE during lifetime (59 %), followed by sudden fatal PE (34 %). It is estimated that only 7 % of patients who died from PE had PE diagnosed on time. 5-7 Frequency of PE is hard to determine because it can sometimes remain asymptomatic and therefore go unsuspected, while on the other hand PE is often accidentally diagnosed as an incidental finding. 8

show abstract

Section: Discussionsupporting

confidence: 92%

D-dimer: A role in ruling out pulmonary embolism in an emergency care department

Hadžić¹,

Maksimović²,

Stajić³

et al. 2020

Scripta Medica

View full text Add to dashboard Cite

show abstract

“…Previous studies showed that there is limited reliability of the D-dimer value as a diagnostic cut-off in hospitalized patients [18][19][20] . Some studies also suggest age-adjusted value of D-dimers would work better as a diagnostic cutoff for both hospitalized patients and outpatients [23][24][25] . Current guidelines, however, and the sGS do not make general use of age-adjusted D-dimer values.…”

Section: Discussionmentioning

confidence: 99%

Appropriateness of CT pulmonary angiograms according to current diagnostic guidelines based on risk stratification: A retrospective single-center study

et al. 2021

View full text Add to dashboard Cite

Background and Aim. Assessment of appropriateness of CT pulmonary angiograms (CTPA) in patients with suspected pulmonary embolism (PE) is based on risk stratification algorithms such as simplified the Geneva Score (sGS) in combination with D-dimer blood tests. The aim of this study was to validate the diagnostic yield and appropriateness of CTPA examinations in accordance with 2014 European Society of Cardiology (ESC) guidelines. Materials and Methods. Data from 155 outpatients who underwent CTPA for clinical suspicion of PE were gathered from the radiology information system (RIS) and the clinical information system (CIS). We assessed the presence of sGS items and D-dimer blood test results in RIS from CTPA request forms and from clinical documentation in CIS. Results. Based on the RIS, there were 2.6% patients with high (sGS≥3) and 97.4% patients with low pre-test PE probability (sGS<3), and CTPA indication was formally comprehendible in 75.5% using sGS and D-dimer blood tests. Based on RIS and CIS data in combination, there were 41.3% patients with high and 58.7% patients with low pre-test PE probability, and CTPA indication was formally comprehendible in 88.4%. Using RIS and CIS in combination, PE probability was upgraded from low to high probability in 39.7% compared with RIS alone. In 12.9%, there was a lack of data in RIS for CTPA justification. Conclusion. There is a high diagnostic yield when applying current diagnostic guidelines to our data. There was however a notable discrepancy between the data transferred to the CTPA request forms from the full clinical documentation, therefore not readily available for clinical decision making.

show abstract

“…El ELISA (enzyme linked immunosorbent assay) cuantitativo u otros análisis derivados de este tienen una sensibilidad diagnóstica del 95% o superior, por lo que pueden utilizarse para excluir la EP en pacientes con una probabilidad previa a la prueba baja o moderada 4,9,23,[35][36][37] . La especificidad del dímero D disminuye con la edad, hasta casi un 10% en pacientes mayores de 80 años 4,36 ; el uso de puntos de corte ajustados por edad mejora el rendimiento del estudio del dímero D en ancianos 4,36 .…”

Section: Enzyme Linked Immunosorbent Assayunclassified

“…La especificidad del dímero D disminuye con la edad, hasta casi un 10% en pacientes mayores de 80 años 4,36 ; el uso de puntos de corte ajustados por edad mejora el rendimiento del estudio del dímero D en ancianos 4,36 . Valores de corte ajustados por edad (edad × 10 μg/l por encima de los 50 años) permitieron aumentar la especificidad del 34 al 46% conservando una sensibilidad superior al 97% 4,23,36,37 .…”

Section: Enzyme Linked Immunosorbent Assayunclassified

Embolia pulmonar en el Servicio de Emergencias: epidemiología, riesgo y abordaje diagnóstico

García¹

2019

REIE

View full text Add to dashboard Cite

Artículo dE rEviSión resumenEn la actualidad la embolia pulmonar constituye un problema de salud pública que requiere asistencia cardiovascular inmediata, debido a que constituye una de las principales causas de mortalidad de origen cardiovascular. La detección de esta patología representa un verdadero desafío en los Servicios de Emergencias (SE), dado por su enfoque de diagnóstico complejo, la inespecificidad de los síntomas y que puede estar enmascarada por otras patologías. La utilización de forma combinada de las diferentes herramientas diagnosticas permitirá hacer un diagnóstico precoz, con el consiguiente manejo eficiente del paciente.

show abstract

Age-Adjusted D-Dimer in the Prediction of Pulmonary Embolism: Does a Normal Age-Adjusted D-Dimer Rule Out PE?

Cited by 9 publications

References 22 publications

D-dimer: A role in ruling out pulmonary embolism in an emergency care department

D-dimer: A role in ruling out pulmonary embolism in an emergency care department

Appropriateness of CT pulmonary angiograms according to current diagnostic guidelines based on risk stratification: A retrospective single-center study

Embolia pulmonar en el Servicio de Emergencias: epidemiología, riesgo y abordaje diagnóstico

Contact Info

Product

Resources

About