Display options
Cite
Khan M, Alter SM, Clayton LM, et al. Age adjusted D-dimer cutoffs for pulmonary embolism in a geriatric population utilizing a D-dimer unit assay. Am J Emerg Med. 2021;51:103-107doi: 10.1016/j.ajem.2021.10.009.
Khan, M., Alter, S. M., Clayton, L. M., Hughes, P. G., Shih, R. D., & Solano, J. J. (2022). Age adjusted D-dimer cutoffs for pulmonary embolism in a geriatric population utilizing a D-dimer unit assay. The American journal of emergency medicine, 51103-107. https://doi.org/10.1016/j.ajem.2021.10.009
Khan, Mohsin, et al. "Age adjusted D-dimer cutoffs for pulmonary embolism in a geriatric population utilizing a D-dimer unit assay." The American journal of emergency medicine vol. 51 (2022): 103-107. doi: https://doi.org/10.1016/j.ajem.2021.10.009
Khan M, Alter SM, Clayton LM, Hughes PG, Shih RD, Solano JJ. Age adjusted D-dimer cutoffs for pulmonary embolism in a geriatric population utilizing a D-dimer unit assay. Am J Emerg Med. 2022 Jan;51:103-107. doi: 10.1016/j.ajem.2021.10.009. Epub 2021 Oct 22. PMID: 34735966.
Copy Download .nbib Format: NLM
Share it on

Am J Emerg Med. 2022 Jan;51:103-107. doi: 10.1016/j.ajem.2021.10.009. Epub 2021 Oct 22.

Age adjusted D-dimer cutoffs for pulmonary embolism in a geriatric population utilizing a D-dimer unit assay.

The American journal of emergency medicine

Mohsin Khan, Scott M Alter, Lisa M Clayton, Patrick G Hughes, Richard D Shih, Joshua J Solano

Affiliations

  1. Division of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, 777 Glades Road, BC-71, Boca Raton, FL 33431, USA. Electronic address: [email protected].
  2. Division of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, 777 Glades Road, BC-71, Boca Raton, FL 33431, USA. Electronic address: [email protected].
  3. Division of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, 777 Glades Road, BC-71, Boca Raton, FL 33431, USA. Electronic address: [email protected].
  4. Division of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, 777 Glades Road, BC-71, Boca Raton, FL 33431, USA. Electronic address: [email protected].
  5. Division of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, 777 Glades Road, BC-71, Boca Raton, FL 33431, USA. Electronic address: [email protected].
  6. Division of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, 777 Glades Road, BC-71, Boca Raton, FL 33431, USA. Electronic address: [email protected].

PMID: 34735966 DOI: 10.1016/j.ajem.2021.10.009

Abstract

BACKGROUND: Age adjusted serum d-dimer (AADD) with clinical decision rules have been utilized to rule out pulmonary embolism (PE) in low-risk patients; however, its use in the geriatric population has been questioned and the use of d-dimer unit (DDU) assay is uncommon.

OBJECTIVE: The present study aims to compare the test characteristics of the AADD (age × 5) measured in DDU with the standard cutoff (DDU < 250) and study hospital laboratory's d-dimer cutoff (DDU < 600) in geriatric patients presenting with suspected PE.

METHODS: This retrospective study enrolled patients ≥65 years old with suspected PE and d-dimer performed between January 1, 2019 and December 31, 2019 who presented to the emergency department (ED). Charts were reviewed for CTA chest and ventilation perfusion imaging results for PE. Diagnostic parameters for each cutoff were calculated for the primary outcome.

RESULTS: 510 patients were included, 20 with PE. There was no significant difference between the sensitivities of AADD (100%, 95% CI: 80-100), standard cutoff (100%, 95% CI: 80-100), and hospital cutoff (90%, 95% CI: 66.9-98.2). The hospital cutoff specificity (22.7%, 95% CI: 17.1-29.3) was significantly greater than the AADD (13.4%, 95% CI: 9.1-19.2) and standard cutoff (10.8%, 95% CI: 7.0-16.3) specificities.

CONCLUSIONS: In geriatric patients presenting to the ED with suspected PE, the AADD measured in DDUs maintained sensitivity with improved specificity compared to standard cutoff. In this population, the AADD would have safely reduced imaging by 19% without missing any PEs. AADD remains a valid tool with high sensitivity and negative predictive value in ruling out PE in geriatric patients.

Copyright © 2021 Elsevier Inc. All rights reserved.

Keywords: D-dimer; Fibrin fibrinogen degradation products; Geriatrics; Pulmonary embolism

Publication Types