Age-adjusted versus clinical probability-adjusted D-dimer to exclude pulmonary embolism

Thrombosis Research
S Takach LapnerC Kearon

Abstract

A low D-dimer can exclude suspected pulmonary embolism (PE) in cases with low or intermediate clinical probability of disease. Yet D-dimer is nonspecific, so many cases without PE require imaging. D-dimer's specificity is improved by increasing the threshold for a positive test with age (age × 10 ng/mL; age-adjusted D-dimer; AADD) or clinical probability of PE (1000 ng/mL if low and 500 ng/mL if intermediate clinical probability; clinical probability-adjusted D-dimer; CPADD). It is unclear which approach is preferable. We report the sensitivity, specificity and negative predictive value (NPV) of AADD compared to CPADD in suspected PE. A retrospective cohort of 3500 consecutive cases imaged for suspected PE at two U.S. emergency departments was assembled. We analyzed cases with low or intermediate clinical probability of PE (Revised Geneva Score) who had a D-dimer. The outcome was acute PE on imaging at presentation. Of the 3500 cases, 1745 were eligible. 37% were low, and 63% were intermediate clinical probability of PE. PE was present in 145 (8.3%) cases. Sensitivity of CPADD was 87.5% vs. 96.6% for AADD (difference 9.1%; 95% CI 4.3% to 14.0%). NPV of CPADD was 97.1% vs. 99.0% for AADD (difference 1.9%; 95% CI, 0.7% to 3.1%). ...Continue Reading

Citations

Dec 7, 2019·Hematology·Erica A Peterson, Agnes Y Y Lee
Sep 13, 2018·CJEM·Kerstin de Wit
Dec 29, 2020·International Journal of General Medicine·Mostafa A AbolfotouhMohammed A Al Rowaily
Feb 8, 2021·The American Journal of Emergency Medicine·Melahat Uzel ŞenerAlp Şener
Nov 25, 2021·Journal of Primary Care & Community Health·Kenneth IwujiDuke Appiah

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