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Age-Dependent D-dimer Cut-off to Avoid Unnecessary CT-Exams for Ruling-out Pulmonary Embolism

M M Altmann1, C E Wrede2, D Peetz3

  • 1Radiology, HELIOS Klinikum Berlin-Buch, Berlin, Germany.

Rofo : Fortschritte Auf Dem Gebiete Der Rontgenstrahlen Und Der Nuklearmedizin
|August 27, 2015
PubMed

Insights

An age-dependent D-dimer cut-off can safely reduce computed tomography pulmonary angiogram (CTPA) use for suspected pulmonary embolism (PE). This strategy identifies more patients with negative results without increasing false negatives.

Area of Science:

  • Medical Diagnostics
  • Cardiovascular Medicine
  • Radiology

Background:

  • Pulmonary embolism (PE) diagnosis often involves computed tomography pulmonary angiogram (CTPA).
  • D-dimer testing is a common initial step, but its specificity can be limited in older adults.
  • An age-dependent D-dimer cut-off may improve diagnostic efficiency.

Purpose of the Study:

  • To evaluate the impact of an age-dependent D-dimer cut-off on CTPA utilization for suspected PE.
  • To assess the diagnostic safety of this adjusted D-dimer threshold.

Main Methods:

  • Retrospective analysis of 530 patients undergoing CTPA for suspected PE.
  • Application of an age-dependent D-dimer cut-off (age/100 for patients >50 years).
  • Evaluation of test results, PE diagnosis, and false-negative rates.

Main Results:

  • An age-dependent D-dimer cut-off identified 3.2% more patients with negative results.
  • In patients over 50, 4.1% had a negative result shift.
  • No false-negative cases of PE were observed, maintaining diagnostic safety (0% false-negative rate).
  • The effect was consistent in both outpatients and inpatients.

Conclusions:

  • Implementing an age-dependent D-dimer cut-off reduces the number of CTPA scans required for suspected PE.
  • This strategy enhances diagnostic efficiency without compromising safety.
  • The age adjustment is effective for both outpatient and inpatient settings.
Abstract

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