Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. After dividing this coefficient by 10, an individual multiplication factor for each age could be obtained. Age-adjusted D-dimer has been investigated in retrospective and some prospective studies. D-dimer has been shown to increase with age, which can cause a lower specificity i. A linear regression analysis of the cut-off values plotted against the age group led to the regression coefficient which represented the increase of the D-dimer cut-off value per decade.
D-dimer has been shown to increase with age, which can cause a lower specificity i. D-dimer testing is sensitive for thrombus formation, and in patients who are not high risk, this test is used to rule-out venous thromboembolism. Assessment of the safety and efficiency of using an age-adjusted D-dimer threshold to exclude suspected pulmonary embolism. We found that with the conventional cut-off value of 80 years. Thus, the D-dimer test to rule out thromboembolic events has a high false positive rate in elderly patients. Reducing the false positive results, the age-adjusted D-dimer cut-off point raises the proportion of older patients in whom an acute thromboembolic event can be safely excluded. Dtsch Arztebl 2005; 102 7 : 428-432.
I have heard some people will multiply by 2 if their cutoff is 250, but that is not evidence based. The emergency medicine approach to the evaluation and treatment of pulmonary embolism. Comparison of the revised Geneva score with the Wells rule for assessing clinical probability of pulmonary embolism. Thromb Haemost 2001; 85 4 : 744. Comparison of the unstructured clinician gestalt, the wells score, and the revised Geneva score to estimate pretest probability for suspected pulmonary embolism. Emerg Med Int 2010; 2010 185453.
How do you perform age adjusted d-dimer testing? A higher d-dimer threshold safely rules-out pulmonary embolism in very elderly emergency department patients. Thus, the D-dimer test to rule out thromboembolic events has a high false positive rate in elderly patients. A systematic review of management outcome studies. So could age adjusted d-dimer testing increase specificity without affecting sensitivity? To simplify, instead of multiplying by 10, you can just multiply by 5. The result of this would be that older patients would often have more diagnostic imaging or downstream testing, but on the other hand, maybe a higher cut-off d-dimer value may lead to increased false negative cases i. Thromb Haemost 2012; 107 1 : 167-171.
It is important to know what type of d-dimer assay you have at your institution and make sure that it correlates to the studies below. An Age-Adjusted D-dimer Threshold for Emergency Department Patients With Suspected Pulmonary Embolus: Accuracy and Clinical Implications. However, before implementing age-adjusted cut-off levels into daily clinical practice in the emergency department, a prospective study is required to confirm the clinical utility, cost effectiveness and ease of use in daily patient care. This allows you to practice good resource management by minimizing unnecessary testing without compromising safety. RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin. Not only older patients would benefit from reducing redundant diagnostic imaging e. Although prospective trials are rare and no recent meta-analysis or clinical policy statement has been issued, there is an abundance of evidence that age-adjusted D-dimer increases specificity with minimal and acceptable decline in sensitivity in the low risk population.
Thromb Haemost 1998; 79 1 : 38-41. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. N Engl J Med 2005; 352 17 : 1760-1768. Application of this approach in different retrospective cohorts confirmed that age adjustment increases specificity while hardly affecting sensitivity. The use of an age-adjusted D-dimer cutoff in ruling out venous thromboembolism for patients over the age of 50 is now largely accepted.
It is important to note that different hospitals will use different assays of d-dimer and so the age adjusted cutoff used in the above studies may not be the same as your institution. Evaluation of Patients With Suspected Acute Pulmonary Embolism: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians. The performance of age-adjusted D-dimer cut-off in Chinese outpatients with suspected venous thromboembolism. What is the newest study to evaluate age adjusted d-dimer testing? Specificity was improved with the age-adjusted D-dimer in all age groups. J Thromb Haemost 2012; 10 7 : 1291-1296. For patients with a non-high clinical probability, 2 × 2 tables were reconstructed and stratified by age category and applied D-dimer cut-off level.
Using the age-adjusted D-dimer cut-off value, this proportion only diminished from 76 % to 32 % in the corresponding age groups. Potential of an age adjusted D-dimer cut-off value to improve the exclusion of pulmonary embolism in older patients: a retrospective analysis of three large cohorts. J Thromb Haemost 2007; 5 9 : 1869-1877. Broadly, d-dimer testing can be described as quantitative tests i. Ultimately, age-adjusted D-dimer aims to increase specificity and therefore decrease unnecessary imaging. With increasing age, an unspecific rise of fibrin degradation product in blood is observed.
Gerontology 1995; 41 3 : 159-165. Sensitivities of the age adjusted cut-off remained above 97% in all age categories. Critical issues in the evaluation and management of adult patients presenting to the emergency department with suspected pulmonary embolism. Thromb Haemost 2000; 83 3 : 416-420. Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis. Recently, I wrote a post on , but since that post there was a new article that was published in Chest 2014. Support Subsequently, at least seven studies have investigated age-adjusted D-dimer Polo Friz et al.