Sex-specific performance of pre-imaging diagnostic algorithms for pulmonary embolism

Area of Science:

• Cardiology
• Pulmonary Medicine
• Diagnostic Imaging

Background:

• Clinical decision rules combined with D-dimer testing help rule out pulmonary embolism (PE) in low-risk patients.
• Current diagnostic algorithms for PE are applied uniformly across sexes, despite known sex differences in disease aspects.
• This approach may overlook sex-specific performance variations in diagnostic tools.

Purpose of the Study:

• To compare the diagnostic performance (efficiency and failure rate) of three pre-imaging algorithms for PE in women versus men.
• To evaluate the Wells rule (fixed and age-adjusted D-dimer) and the YEARS algorithm.
• To determine sex-specific prevalence of PE and identify factors influencing it.

Main Methods:

• Individual patient data from six studies using the Wells rule and one study using the YEARS algorithm were analyzed.
• All studies prospectively enrolled consecutive patients with suspected PE.
• Performance outcomes (efficiency, failure rate) were estimated using multilevel logistic regression models.

Main Results:

• No significant sex differences were found in the performance of the Wells rule or the YEARS algorithm for diagnosing PE.
• The prevalence of PE was lower in women compared to men across all evaluated algorithms.
• Estrogen use in women was associated with lower algorithm efficiency, higher PE prevalence, and elevated D-dimer levels.

Conclusions:

• Pre-imaging diagnostic algorithms for suspected PE demonstrate consistent performance across sexes.
• Male sex and estrogen use are independently associated with an increased probability of pulmonary embolism.
• These findings suggest that while algorithm performance is consistent, sex-specific prevalence rates warrant consideration in clinical practice.