BET 2: Should we use an age adjusted D-dimer threshold in managing low risk patients with suspected pulmonary embolism?

Jaconelli, Tom; Crane, Steven

doi:10.1136/emermed-2015-204681.2

Cited by 3 publications

(2 citation statements)

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“…Some advocate that D‐dimer testing should be entirely avoided in the elderly , but the effect of this approach would be that patients had to undergo imaging techniques instead, even if the probability of VTE were low. Age‐adjusted cut‐offs have been previously validated and recommended in DVT and PE to increase specificity in older patients while preserving sensitivity. However, this has been questioned , and a recent Cochrane review of D‐dimer to rule out pulmonary embolism did not find enough evidence to recommend age‐adjusted cut‐offs .…”

Section: Introductionmentioning

confidence: 99%

Age‐adjusted D‐dimer cut‐off leads to more efficient diagnosis of venous thromboembolism in the emergency department: a comparison of four assays

Farm

Siddiqui

Onelöv

et al. 2018

Journal of Thrombosis and Haemostasis

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Background The study compares different D-dimer assays and age-adjusted cut-offs in outpatients with suspected venous thromboembolism (VTE). The plasma concentration of this sensitive biomarker is increased by activated coagulation, but also by several conditions that are linked to an increased risk of VTE. One such condition is old age, which poses a common clinical problem where many prefer not to analyze D-dimer in elderly patients. Age-adjusted cut-offs have been validated for both deep venous thrombosis (DVT) and pulmonary embolism, aiming to increase specificity without notably decreasing sensitivity. Objectives We evaluated four common D-dimer assays in parallel, with and without applying age-adjusted cut offs for VTE. Patients/methods The prospective single-center study was conducted in 940 outpatients attending the emergency department with clinically suspected pulmonary embolism or DVT. Four automated D-dimer assays were compared (Siemens INNOVANCE , Roche Tina-quant, Medirox MRX and STA -Liatest D-Di PLUS). Results All assays performed with areas under the ROC curve (AUC) > 0.9 and maintained their sensitivities after implementation of age-adjusted cut-offs. Specificities increased by 6-7% and number needed to test decreased by < 0.3. The rate of false positive results decreased by 6% overall and by 10-20% for patients ≥ 70. Conclusions Age-adjusted cut-offs resulted in maintained high sensitivity and a modest improvement in specificity and number needed to test for all evaluated D-dimer assays. There was a significant reduction in false positive results, which reflects avoidable unnecessary imaging without any compromise of clinical safety. This suggests a potential to benefit the management of VTE in elderly patients, both clinically and economically.

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Section: Introductionmentioning

confidence: 99%

Age‐adjusted D‐dimer cut‐off leads to more efficient diagnosis of venous thromboembolism in the emergency department: a comparison of four assays

Farm

Siddiqui

Onelöv

et al. 2018

Journal of Thrombosis and Haemostasis

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“…It has been suggested that age-adjusted D-dimer reference ranges have higher sensitivity and specificity for PE [19][20][21][22] . This is particularly in the context of a low pre-test probability 23 .…”

Section: Discussionmentioning

confidence: 99%

D-dimer level has higher correlation with pulmonary embolism diagnosis than a clinical prediction score

Alipour²,

Mitric

et al. 2021

Preprint

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Aim This study aimed to compare the predictive value of D-dimer and a clinical prediction score in diagnosis of pulmonary embolism (PE) as this could improve practice and reduce costs simultaneously. Method To achieve this, medical records of patients who presented to the Emergency Department of a large Australian metropolitan general hospital over 12 months and underwent DD testing were reviewed. The correlation coefficient (CC) was calculated using the Cramer’s V method. Results CC between low-, intermediate- and high-risk groups on their own and a final diagnosis of PE on imaging was 0.1332, 0.1278 and 0.0817, respectively. By contrast, the CC when using positive DD was higher for all categories: 0.7527, 0.6256 and 0.4195, respectively. For the age-adjusted DD, the correlations were higher than for the clinical prediction score but less than for the absolute DD; calculated at 0.6490, 0.4987 and 0.3550 for the respective groups. The overall CC for risk category was 0.1107; for a positive DD, it was 0.7033; for the age-adjusted DD, it was 0.5928. Conclusion Positive DD has a higher correlation with PE diagnosis than the clinical prediction score. DD assay, whether positive or negative, is therefore an invaluable test in assessment of patients with suspected PE and can help determine the need for tomographic imaging. The absolute DD is more useful than the age-adjusted value.

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Respiratory Emergencies in Geriatric Patients

Tyler

Stevenson

2016

Emergency Medicine Clinics of North America

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BET 2: Should we use an age adjusted D-dimer threshold in managing low risk patients with suspected pulmonary embolism?

Cited by 3 publications

References 1 publication

Age‐adjusted D‐dimer cut‐off leads to more efficient diagnosis of venous thromboembolism in the emergency department: a comparison of four assays

Age‐adjusted D‐dimer cut‐off leads to more efficient diagnosis of venous thromboembolism in the emergency department: a comparison of four assays

D-dimer level has higher correlation with pulmonary embolism diagnosis than a clinical prediction score

Respiratory Emergencies in Geriatric Patients

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