Publication Date

2014

Journal Title

Am J Emerg Med

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 chi2 tests with proportional analyses to assess differences in traditional and age-adjusted (agex10 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 score50 years with Wells score

Volume Number

32

Issue Number

12

Pages

1499-502

Document Type

Article

EPub Date

2014/10/12

Status

Faculty

Facility

School of Medicine

Primary Department

Emergency Medicine

PMID

25303849

DOI

10.1016/j.ajem.2014.09.027


Share

COinS