Tags

Type your tag names separated by a space and hit enter

A higher d-dimer threshold safely rules-out pulmonary embolism in very elderly emergency department patients.
Thromb Res. 2014 Mar; 133(3):380-3.TR

Abstract

INTRODUCTION

D-dimer is commonly used in the workup of suspected Pulmonary Embolism (PE), but its specificity decreases with age. We evaluated whether using a higher cutoff value for D-dimer could increase the test specificity without reducing its sensitivity for ruling-out PE in elderly and very elderly patients presenting to the Emergency Department (ED).

MATERIAL AND METHODS

All patients with D-dimer and pulmonary Computed Tomography Angiography (CTA) performed in the ED of Vimercate Hospital, from 2010 through 2012 for clinical suspicion of PE were included in this retrospective cohort study.

RESULTS

Study population 481 patients (63.4% women, mean age 73.0 ± 16.1 years, confirmed PE 22.5%). In very elderly patients (aged 80 or more years, n=191), compared with standard 490 ng/mL D-dimer threshold, both higher fixed (1000 ng/mL) and age-adjusted cutoffs increase the specificity of D-dimer for the exclusion of PE maintaining a Negative Predictive Value of 100%. Potentially avoided CTAs were 12(6.3%) using 1000 ng/mL cutoff and 10(5.2%) age-adjusted. In very elderly patients the Number Needed to Test was incalculable for the standard cutoff (0 cases), 16 for 1000 ng/mL and 19 for age-adjusted. In patients with PE, index episode mortality was 6.5%, and death occurred only in subjects with D-dimer values above 1000ng/mL and age-adjusted thresholds.

CONCLUSION

For very elderly patients with suspected PE in ED, both higher fixed D-dimer (1000 ng/mL) and age-adjusted thresholds increase test specificity for excluding PE without reducing its sensitivity, leading to a safe reduction in the number of CTAs.

Authors+Show Affiliations

Internal Medicine, Medical Department, Vimercate Hospital, Vimercate, Italy. Electronic address: polofriz@libero.it.Internal Medicine, Medical Department, Vimercate Hospital, Vimercate, Italy.Internal Medicine, Medical Department, Vimercate Hospital, Vimercate, Italy.Internal Medicine, Medical Department, Vimercate Hospital, Vimercate, Italy.Internal Medicine, Medical Department, Vimercate Hospital, Vimercate, Italy.Internal Medicine, Medical Department, Vimercate Hospital, Vimercate, Italy.Internal Medicine, Medical Department, Vimercate Hospital, Vimercate, Italy.Internal Medicine, Medical Department, Vimercate Hospital, Vimercate, Italy.Internal Medicine, Medical Department, Vimercate Hospital, Vimercate, Italy.Internal Medicine, Medical Department, Vimercate Hospital, Vimercate, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24439678

Citation

Polo Friz, Hernan, et al. "A Higher D-dimer Threshold Safely Rules-out Pulmonary Embolism in Very Elderly Emergency Department Patients." Thrombosis Research, vol. 133, no. 3, 2014, pp. 380-3.
Polo Friz H, Pasciuti L, Meloni DF, et al. A higher d-dimer threshold safely rules-out pulmonary embolism in very elderly emergency department patients. Thromb Res. 2014;133(3):380-3.
Polo Friz, H., Pasciuti, L., Meloni, D. F., Crippa, M., Villa, G., Molteni, M., Primitz, L., Del Sorbo, D., Delgrossi, G., & Cimminiello, C. (2014). A higher d-dimer threshold safely rules-out pulmonary embolism in very elderly emergency department patients. Thrombosis Research, 133(3), 380-3. https://doi.org/10.1016/j.thromres.2013.12.045
Polo Friz H, et al. A Higher D-dimer Threshold Safely Rules-out Pulmonary Embolism in Very Elderly Emergency Department Patients. Thromb Res. 2014;133(3):380-3. PubMed PMID: 24439678.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A higher d-dimer threshold safely rules-out pulmonary embolism in very elderly emergency department patients. AU - Polo Friz,Hernan, AU - Pasciuti,Lorenzo, AU - Meloni,Dario Francesco, AU - Crippa,Matteo, AU - Villa,Giulia, AU - Molteni,Mauro, AU - Primitz,Laura, AU - Del Sorbo,Davide, AU - Delgrossi,Giovanni, AU - Cimminiello,Claudio, Y1 - 2014/01/07/ PY - 2013/11/27/received PY - 2013/12/24/revised PY - 2013/12/31/accepted PY - 2014/1/21/entrez PY - 2014/1/21/pubmed PY - 2014/12/31/medline KW - Cutoff values KW - D-dimer KW - Pulmonary computed tomography angiography KW - Pulmonary embolism KW - Very elderly SP - 380 EP - 3 JF - Thrombosis research JO - Thromb Res VL - 133 IS - 3 N2 - INTRODUCTION: D-dimer is commonly used in the workup of suspected Pulmonary Embolism (PE), but its specificity decreases with age. We evaluated whether using a higher cutoff value for D-dimer could increase the test specificity without reducing its sensitivity for ruling-out PE in elderly and very elderly patients presenting to the Emergency Department (ED). MATERIAL AND METHODS: All patients with D-dimer and pulmonary Computed Tomography Angiography (CTA) performed in the ED of Vimercate Hospital, from 2010 through 2012 for clinical suspicion of PE were included in this retrospective cohort study. RESULTS: Study population 481 patients (63.4% women, mean age 73.0 ± 16.1 years, confirmed PE 22.5%). In very elderly patients (aged 80 or more years, n=191), compared with standard 490 ng/mL D-dimer threshold, both higher fixed (1000 ng/mL) and age-adjusted cutoffs increase the specificity of D-dimer for the exclusion of PE maintaining a Negative Predictive Value of 100%. Potentially avoided CTAs were 12(6.3%) using 1000 ng/mL cutoff and 10(5.2%) age-adjusted. In very elderly patients the Number Needed to Test was incalculable for the standard cutoff (0 cases), 16 for 1000 ng/mL and 19 for age-adjusted. In patients with PE, index episode mortality was 6.5%, and death occurred only in subjects with D-dimer values above 1000ng/mL and age-adjusted thresholds. CONCLUSION: For very elderly patients with suspected PE in ED, both higher fixed D-dimer (1000 ng/mL) and age-adjusted thresholds increase test specificity for excluding PE without reducing its sensitivity, leading to a safe reduction in the number of CTAs. SN - 1879-2472 UR - https://www.unboundmedicine.com/medline/citation/24439678/A_higher_d_dimer_threshold_safely_rules_out_pulmonary_embolism_in_very_elderly_emergency_department_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0049-3848(14)00009-7 DB - PRIME DP - Unbound Medicine ER -