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Rapid Systematic Review: Age-Adjusted D-Dimer for Ruling Out Pulmonary Embolism
Bradley E Barth1, Grzegorz Waligora2, Gary M Gaddis3
1University of Kansas Medical Center, Kansas City, Kansas.
The Journal of Emergency Medicine
|August 19, 2018
Summary
Age-adjusted D-dimer testing can safely rule out pulmonary embolism (PE) in emergency department patients over 50. This approach reduces unnecessary testing and radiation exposure, improving diagnostic decision-making.
Area of Science:
- Emergency Medicine
- Diagnostic Imaging
- Cardiology
Background:
- Pulmonary embolism (PE) is frequently diagnosed in emergency departments (EDs).
- Improved diagnostic decision-making can reduce inappropriate testing, radiation exposure, and non-beneficial treatments.
- Age-adjusting D-dimer levels is being explored for safe PE exclusion.
Purpose of the Study:
- To determine if an age-adjusted D-dimer can be safely used to rule out PE in patients over 50 years old.
Main Methods:
- A rapid systematic review of PubMed (January 2012-January 2018) was conducted.
- Studies involving human subjects, in English, with relevant keywords were included.
- The highest-quality studies were reviewed in a structured format.
Main Results:
- 111 papers were identified; 8 were included in the summary.
- Studies defined age-adjusted D-dimer as: patient age (years over 50) × 10 μg/L (FEU).
Conclusions:
- Age-adjusted D-dimer cutoff values are safe and effective for ruling out PE in ED patients.
- This method should be used in conjunction with a non-high clinical probability assessment.
- This strategy can decrease unnecessary testing and radiation exposure.
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