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Assessing 2 D-dimer age-adjustment strategies to optimize computed tomographic use in ED evaluation of pulmonary embolism.
Am J Emerg Med. 2014 Dec; 32(12):1499-502.AJ

Abstract

STUDY OBJECTIVE

Validate the sensitivity and specificity of 2 age adjustment strategies for d-dimer values in identifying patients at risk for pulmonary embolism (PE) compared with traditional D-dimer cutoff value (500 ng/mL) to decrease inappropriate computed tomography pulmonary angiography (CTPA) use.

METHODS

This institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study included all adult emergency department patients evaluated for PE over a 32-month period (1/1/11-8/30/13). Only patients undergoing CTPA and D-dimer testing were included. We used a validated natural language processing algorithm to parse CTPA radiology reports and determine the presence of acute PE. Outcome measures were sensitivity and specificity of 2 age-adjusted D-dimer cutoffs compared with the traditional cutoff. We used χ2 tests with proportional analyses to assess differences in traditional and age-adjusted (age×10 ng/mL) D-dimer cutoffs, adjusting both by decade and by year.

RESULTS

A total 3063 patients with suspected PE were evaluated by CTPA during the study period, and 1055 (34%) also received d-dimer testing. The specificity of age-adjusted D-dimer values was similar or higher for each age group studied compared with traditional cutoff, without significantly compromising sensitivity. Overall, had decade age-adjusted cutoffs been used, 37 CTPAs could have been avoided (19.6% of 189 patients aged >60 years with Wells score≤4); had yearly age-adjusted cutoffs been used, 52 CTPAs (18.2% of 286 patients aged >50 years with Wells score≤4) could have been avoided.

CONCLUSION

Each age-adjusted D-dimer cutoff strategy for the evaluation of PE was associated with increased specificity and statistically insignificant decreased sensitivity when compared with the traditional D-dimer cutoff value.

Authors+Show Affiliations

Center for Evidence-Based Imaging, Brigham and Women's Hospital, Brookline, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: anuraggz@gmail.com.Center for Evidence-Based Imaging, Brigham and Women's Hospital, Brookline, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.Center for Evidence-Based Imaging, Brigham and Women's Hospital, Brookline, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.Center for Evidence-Based Imaging, Brigham and Women's Hospital, Brookline, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25303849

Citation

Gupta, Anurag, et al. "Assessing 2 D-dimer Age-adjustment Strategies to Optimize Computed Tomographic Use in ED Evaluation of Pulmonary Embolism." The American Journal of Emergency Medicine, vol. 32, no. 12, 2014, pp. 1499-502.
Gupta A, Raja AS, Ip IK, et al. Assessing 2 D-dimer age-adjustment strategies to optimize computed tomographic use in ED evaluation of pulmonary embolism. Am J Emerg Med. 2014;32(12):1499-502.
Gupta, A., Raja, A. S., Ip, I. K., & Khorasani, R. (2014). Assessing 2 D-dimer age-adjustment strategies to optimize computed tomographic use in ED evaluation of pulmonary embolism. The American Journal of Emergency Medicine, 32(12), 1499-502. https://doi.org/10.1016/j.ajem.2014.09.027
Gupta A, et al. Assessing 2 D-dimer Age-adjustment Strategies to Optimize Computed Tomographic Use in ED Evaluation of Pulmonary Embolism. Am J Emerg Med. 2014;32(12):1499-502. PubMed PMID: 25303849.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessing 2 D-dimer age-adjustment strategies to optimize computed tomographic use in ED evaluation of pulmonary embolism. AU - Gupta,Anurag, AU - Raja,Ali S, AU - Ip,Ivan K, AU - Khorasani,Ramin, Y1 - 2014/09/28/ PY - 2014/05/27/received PY - 2014/09/08/revised PY - 2014/09/17/accepted PY - 2014/10/12/entrez PY - 2014/10/12/pubmed PY - 2015/3/13/medline SP - 1499 EP - 502 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 32 IS - 12 N2 - STUDY OBJECTIVE: Validate the sensitivity and specificity of 2 age adjustment strategies for d-dimer values in identifying patients at risk for pulmonary embolism (PE) compared with traditional D-dimer cutoff value (500 ng/mL) to decrease inappropriate computed tomography pulmonary angiography (CTPA) use. METHODS: This institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study included all adult emergency department patients evaluated for PE over a 32-month period (1/1/11-8/30/13). Only patients undergoing CTPA and D-dimer testing were included. We used a validated natural language processing algorithm to parse CTPA radiology reports and determine the presence of acute PE. Outcome measures were sensitivity and specificity of 2 age-adjusted D-dimer cutoffs compared with the traditional cutoff. We used χ2 tests with proportional analyses to assess differences in traditional and age-adjusted (age×10 ng/mL) D-dimer cutoffs, adjusting both by decade and by year. RESULTS: A total 3063 patients with suspected PE were evaluated by CTPA during the study period, and 1055 (34%) also received d-dimer testing. The specificity of age-adjusted D-dimer values was similar or higher for each age group studied compared with traditional cutoff, without significantly compromising sensitivity. Overall, had decade age-adjusted cutoffs been used, 37 CTPAs could have been avoided (19.6% of 189 patients aged >60 years with Wells score≤4); had yearly age-adjusted cutoffs been used, 52 CTPAs (18.2% of 286 patients aged >50 years with Wells score≤4) could have been avoided. CONCLUSION: Each age-adjusted D-dimer cutoff strategy for the evaluation of PE was associated with increased specificity and statistically insignificant decreased sensitivity when compared with the traditional D-dimer cutoff value. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/25303849/Assessing_2_D_dimer_age_adjustment_strategies_to_optimize_computed_tomographic_use_in_ED_evaluation_of_pulmonary_embolism_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(14)00678-0 DB - PRIME DP - Unbound Medicine ER -