Diagnostic utility of an age‐specific cut‐off for d‐dimer for pulmonary embolism assessment when used with various pulmonary embolism risk scores

Ackerly, Imogen; Klim, Sharon; McFarlane, James R.; Kelly, Anne‐Maree

doi:10.1111/imj.13753

Cited by 4 publications

(3 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study findings confirmed that all three predictive tools have excellent and comparable negative predictive value when combined with D-dimer regardless of the D-dimer threshold [14,34]. The highest sensitivity to rule out PE was observed with the combination of low CP per YEARS algorithm with D-dimer < age-adjusted cut-off (83%) and the combination of low CP per Well's score and D-dimer < age-adjusted cut-off (82%).…”

Section: Discussionsupporting

confidence: 79%

Assessment of the Utilization of Validated Diagnostic Predictive Tools and D-Dimer in the Evaluation of Pulmonary Embolism: A Single-Center Retrospective Cohort Study from a Public Hospital in New York City

Kharawala,

Seo,

Barzallo

et al. 2023

JCM

View full text Add to dashboard Cite

Introduction: A significant increase in the use of computed tomography with pulmonary angiography (CTPA) for the diagnosis of pulmonary embolism (PE) has been observed in the past twenty years. We aimed to investigate whether the validated diagnostic predictive tools and D-dimers were adequately utilized in a large public hospital in New York City. Methods: We conducted a retrospective review of patients who underwent CTPA for the specific indication of ruling out PE over a period of one year. Two independent reviewers, blinded to each other and to the CTPA and D-dimer results, estimated the clinical probability (CP) of PE using Well’s score, the YEARS algorithm, and the revised Geneva score. Patients were classified based on the presence or absence of PE in the CTPA. Results: A total of 917 patients were included in the analysis (median age: 57 years, female: 59%). The clinical probability of PE was considered low by both independent reviewers in 563 (61.4%), 487 (55%), and 184 (20.1%) patients based on Well’s score, the YEARS algorithm, and the revised Geneva score, respectively. D-dimer testing was conducted in less than half of the patients who were deemed to have low CP for PE by both independent reviewers. Using a D-dimer cut-off of <500 ng/mL or the age-adjusted cut-off in patients with a low CP of PE would have missed only a small number of mainly subsegmental PE. All three tools, when combined with D-dimer < 500 ng/mL or <age-adjusted cut-off, yielded a NPV of > 95%. Conclusion: All three validated diagnostic predictive tools were found to have significant diagnostic value in ruling out PE when combined with a D-dimer cut-off of <500 ng/mL or the age-adjusted cut-off. Excessive use of CTPA was likely secondary to suboptimal use of diagnostic predictive tools.

show abstract

Section: Discussionsupporting

confidence: 79%

Assessment of the Utilization of Validated Diagnostic Predictive Tools and D-Dimer in the Evaluation of Pulmonary Embolism: A Single-Center Retrospective Cohort Study from a Public Hospital in New York City

Kharawala,

Seo,

Barzallo

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…All patients in the present study were successfully treated, but required a peripherally inserted central catheter and a prolonged course of IV meropenem through our ambulatory parenteral antibiotic programme. Whether there were specific bacterial virulence phenotypes or genetic polymorphisms 15 to account for the absence of severe invasive disease remains the focus of further study of these isolates.…”

Section: Brief Communicationsmentioning

confidence: 99%

Clinical features and outcome of patients with cutaneous melioidosis during a nosocomial outbreak in a temperate region of Australia

Clark

Merritt

Inglis

et al. 2018

Internal Medicine Journal

View full text Add to dashboard Cite

show abstract

“…As a result, information regarding the ability to rule out VTE based on a D-dimer assay, with or without CDRs, in hospitalized patients is scarce 9 , 10 . The use of age-adjusted D-dimer (AADD) was well-validated in several studies in the recent decade 11 – 13 , and it is used in combination with varied risk assessment scores for pulmonary embolism (PE) 14 .…”

Section: Introductionmentioning

confidence: 99%

Current use of D-dimer for the exclusion of venous thrombosis in hospitalized patients

Karny-Epstein

Abuhasira

Grossman

2022

Sci Rep

View full text Add to dashboard Cite

D-dimer assay’s utility for excluding venous thromboembolism (VTE) in hospitalized patients is debatable. We aimed to assess the current use of D-dimer as a diagnostic tool for excluding VTE in hospitalized patients and examine a mandatory age-adjusted D-dimer (AADD) threshold for diagnostic imaging. Retrospective cohort study between 2014 to 2019 that included patients from medical and surgical wards with a positive AADD result drawn during their hospitalization. The outcomes were determining a D-dimer threshold requiring further evaluation and assessing the prognostic value of D-dimer in predicting clinically relevant VTE in hospitalized patients. The cohort included 354 patients, 56% of them underwent definitive diagnostic imaging, and 7.6% were diagnosed with VTE after a positive AADD within 90 days of follow-up. Mortality rates were higher in patients diagnosed with VTE (33.3% vs. 15.9%, p = 0.03). Patients with pneumonia and other infectious etiologies were less likely to be further evaluated by definitive imaging (p = 0.001). Patients with a respiratory complaint (p = 0.02), chest pain (p < 0.001), or leg swelling (p = 0.01) were more likely to undergo diagnostic imaging. Patients with D-dimer levels > X2 the AADD were at increased risk of VTE [OR 3.87 (1.45–10.27)]. At 90 days of follow-up, no excess mortality was observed for patients without diagnostic evaluation following elevated AADD. D-dimer may be used in hospitalized patients to exclude VTE using the traditional AADD thresholds, with a high negative predictive value. D-dimer levels > X2 the AADD usually mandates further diagnostic imaging, while lower levels, probably do not require additional workup, with a sensitivity of almost 80% and no excess mortality.

show abstract

Diagnostic utility of an age‐specific cut‐off for d‐dimer for pulmonary embolism assessment when used with various pulmonary embolism risk scores

Cited by 4 publications

References 23 publications

Assessment of the Utilization of Validated Diagnostic Predictive Tools and D-Dimer in the Evaluation of Pulmonary Embolism: A Single-Center Retrospective Cohort Study from a Public Hospital in New York City

Assessment of the Utilization of Validated Diagnostic Predictive Tools and D-Dimer in the Evaluation of Pulmonary Embolism: A Single-Center Retrospective Cohort Study from a Public Hospital in New York City

Clinical features and outcome of patients with cutaneous melioidosis during a nosocomial outbreak in a temperate region of Australia

Current use of D-dimer for the exclusion of venous thrombosis in hospitalized patients

Contact Info

Product

Resources

About