Assessment of the safety and efficiency of using an age-adjusted D-dimer threshold to exclude suspected pulmonary embolism.

@article{Woller2014AssessmentOT,
  title={Assessment of the safety and efficiency of using an age-adjusted D-dimer threshold to exclude suspected pulmonary embolism.},
  author={Scott C. Woller and Scott M Stevens and Daniel M. Adams and R. Scott Evans and James F. Lloyd and Greg Snow and Joseph Bledsoe and David Z Gay and Rich Patten and Valerie T. Aston and Charles Gregory Elliott},
  journal={Chest},
  year={2014},
  volume={146 6},
  pages={
          1444-1451
        }
}
BACKGROUND D-dimer levels increase with age, and research has suggested that using an age-adjusted D-dimer threshold may improve diagnostic efficiency without compromising safety. The objective of this study was to assess the safety of using an age-adjusted D-dimer threshold in the workup of patients with suspected pulmonary embolism (PE). METHODS We report the outcomes of 923 patients aged > 50 years presenting to our ED with suspected PE, a calculated Revised Geneva Score (RGS), and a D… 
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Clinical usefulness and safety of an age-adjusted D-dimer cutoff levels to exclude pulmonary embolism: a retrospective analysis
TLDR
Age-adjusted D-dimer increases clinical usefulness notably with respect to that of CDD in patients with clinical suspected PE without losing sensitivity in the authors' cohort, and the use of AADD apparently does not reduce the safety ofCDD for the exclusion of PE.
Age-adjusted versus clinical probability-adjusted D-dimer to exclude pulmonary embolism.
An Age-Adjusted D-dimer Threshold for Emergency Department Patients With Suspected Pulmonary Embolus: Accuracy and Clinical Implications.
Comparison of clinical probability-adjusted D-dimer and age-adjusted D-dimer interpretation to exclude venous thromboembolism.
TLDR
Comparing the diagnostic accuracy of age-adjusted and clinical probability-adjusted D-dimer interpretation in patients with a low or moderate clinical probability of venous thromboembolism (VTE), and the negative predictive value (NPV) for VTE, suggests thatclinical probability- adjusted D-Dimer interpretation is a better way of interpreting D- dimer results compared to age- adjusted interpretation.
Can an age-adjusted D-dimer level be adopted in managing venous thromboembolism in the emergency department? A retrospective cohort study
  • T. Jaconelli, M. Eragat, S. Crane
  • Medicine
    European journal of emergency medicine : official journal of the European Society for Emergency Medicine
  • 2018
TLDR
For patients over the age of 50 years suspected of having VTE with a low pretest probability, increasing the D-dimer cut-off level to 5× the age increases the proportion of patients in whom VTE can safely be excluded without radiological imaging.
Age‑adjusted plasma D‑dimer levels in suspected acute pulmonary embolism: a retrospective, single‑center study.
TLDR
The YADD thresholds are characterized by high sensitivity and increased specificity when compared with CDD, thus allowing for a safe reduction of the number of CT scans, and a prospective study should be conducted to validate these results.
Issues Surrounding Age-Adjusted d-Dimer Cutoffs That Practicing Physicians Need to Know When Evaluating Patients With Suspected Pulmonary Embolism
TLDR
The authors recommend age-adjusted d-dimer (AADD) cutoffs based on several recently published studies, which demonstrated that the use of AADD cutoffs for patients older than 50 years improved specificity for diagnosing pulmonary embolism while maintaining at least 97% sensitivity.
BET 2: Should we use an age adjusted D-dimer threshold in managing low risk patients with suspected pulmonary embolism?
TLDR
The clinical bottom line is that in older patients suspected of having a Pulmonary Embolus, with a low pretest possibility, an age-adjusted D-dimer increases specificity with minimal change in the patient, thereby increasing the number of patients who can be safely discharged without further investigations.
Non-high risk PE in the patients with acute or exacerbated respiratory disease: the value of the algorithm based on D-dimer evaluation and Revised Geneva Score.
TLDR
In the group of the patients with acute respiratory symptoms, low or intermediate clinical probability scoring combined with normal DD had a high NPV in excluding PE, Nevertheless, such approach was not very effective, as the increased DD was noted in 88% of the examined population.
Value of D-dimer levels for the diagnosis of pulmonary embolism: An analysis of 32 cases with computed tomography pulmonary angiography.
TLDR
D-dimer could be a simple, fast and inexpensive screening method for excluding a diagnosis of PE in patients with suspected PE at the Affiliated Hospital of Yan'an University.
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