More Support for Age Adjustment of D-Dimer Results in Pulmonary Embolus Testing

Using a higher threshold leads to fewer unnecessary computed tomography angiograms.

It is normal for older people to have higher d-dimer levels than younger people. Using the same cutoff for all ages when testing for pulmonary embolus (PE) therefore leads to false positive results among older patients. We previously reported on a high-quality study supporting age adjustment of d-dimer results during PE evaluation (NEJM JW Emerg Med Apr 2014 and JAMA 2014; 311:1117). Now, investigators have retrospectively assessed the accuracy of an age-adjusted d-dimer threshold in patients aged >50 who were evaluated for PE in the Kaiser Permanente Southern California system from 2008 to 2013.

Among 31,094 emergency department patients with symptoms suggestive of PE, there were 507 PE diagnoses. The d-dimer threshold used in routine pract…

Reviewing Author

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

More Support for Age Adjustment of D-Dimer Results in Pulmonary Embolus Testing

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Reviewing Author