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

Altmann, M.; Wrede, CE; Peetz, D.; Höhne, Marek Sancho; Stroszczynski, Christian; Herold, Thomas

doi:10.1055/s-0035-1553428

Cited by 6 publications

(7 citation statements)

References 17 publications

(23 reference statements)

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“…This high prevalence of CTPA ordered on otherwise low-risk patients is not unique to our site, and has in fact been reported in similar rates in other studies [30,31]. It should be noted that our results did show a slightly higher proportion of clinically significant pulmonary emboli (2.9%) among D-Dimer negative patients than has been found in previous similar studies [8,[30][31][32][33][34][35]. This slight discrepancy may be due to the different D-Dimer assays used in the different studies, or sample sizes too small in those studies to capture D-Dimer false negative patients, a higher prevalence in our study of patients with chronic PE or already on anticoagulants, or variability and discordance among radiologists in their interpretations of CTPAs and diagnosis of pulmonary embolism [12,36].…”

Section: Discussionsupporting

confidence: 89%

Utilization of serum D-dimer assays prior to computed tomography pulmonary angiography scans in the diagnosis of pulmonary embolism among emergency department physicians: a retrospective observational study

Salehi

Phalpher

et al. 2021

BMC Emerg Med

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Background A variety of evidence-based algorithms and decision rules using D-Dimer testing have been proposed as instruments to allow physicians to safely rule out a pulmonary embolism (PE) in low-risk patients. Objective To describe the prevalence of D-Dimer utilization among emergency department (ED) physicians and its impact on positive yields and utilization rates of Computed Tomography Pulmonary Angiography (CTPA). Methods Data was collected on all CTPA studies ordered by ED physicians at three sites during a 2-year period. Using a chi-square test, we compared the diagnostic yield for those patients who had a D-Dimer prior to their CTPA and those who did not. Secondary analysis was done to examine the impact of D-Dimer testing prior to CTPA on individual physician diagnostic yield or utilization rate. Results A total of 2811 CTPAs were included in the analysis. Of these, 964 CTPAs (34.3%) were ordered without a D-Dimer, and 343 (18.7%) underwent a CTPA despite a negative D-Dimer. Those CTPAs preceded by a D-Dimer showed no significant difference in positive yields when compared to those ordered without a D-Dimer (9.9% versus 11.3%, p = 0.26). At the individual physician level, no statistically significant relationship was found between D-Dimer utilization and CTPA utilization rate or diagnostic yield. Conclusion This study provides evidence of suboptimal adherence to guidelines in terms of D-Dimer screening prior to CTPA, and forgoing CTPAs in patients with negative D-Dimers. However, the lack of a positive impact of D-Dimer testing on either CTPA diagnostic yield or utilization rate is indicative of issues relating to the high false-positive rates associated with D-Dimer screening.

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Section: Discussionsupporting

confidence: 89%

Utilization of serum D-dimer assays prior to computed tomography pulmonary angiography scans in the diagnosis of pulmonary embolism among emergency department physicians: a retrospective observational study

Salehi

Phalpher

et al. 2021

BMC Emerg Med

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“…However, its clinical usage is limited due to high false‐negative rate. 26 , 27 , 28 , 29 , 30 , 31 The results of our study showed that SCUBE‐1 is less sensitive than D‐dimmer in the diagnosis of PE, but it has great advantages in specificity. Therefore, it may be considered as a first‐line screening tool to rule out the false PE risk.…”

Section: Discussionmentioning

confidence: 70%

“…D‐dimer is a product of the fibrinolysis process, and coagulation activation is recommended as an initial test in all PE guidelines. However, its clinical usage is limited due to high false‐negative rate 26–31 . The results of our study showed that SCUBE‐1 is less sensitive than D‐dimmer in the diagnosis of PE, but it has great advantages in specificity.…”

Section: Discussionmentioning

confidence: 79%

The diagnostic potential of plasma SCUBE‐1 concentration for pulmonary embolism: A pilot study

Xiao

Wang

Yang

et al. 2023

Clinical Respiratory J

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Introduction This study aimed to investigate the potential application of plasma signal peptide‐complement C1r/C1s, Uegf and Bmp1‐epidermal growth factor domain‐containing protein 1 (SCUBE‐1) as a biomarker in the diagnosis of pulmonary embolism (PE). Methods This cross‐sectional study enrolled 177 patients who underwent PE diagnostic test and 87 healthy controls. The results of CT pulmonary angiogram (CTPA) were used as reference standards for PE diagnosis. The levels of SCUBE‐1 and D‐dimer in participants' plasma were detected with enzyme‐linked immunosorbent assay and compared among patients with confirmed PE, suspicious PE and healthy controls. The diagnostic values were analysed using receiver operating characteristic (ROC) curve analysis. In addition, differences in plasma SCUBE‐1 levels were compared among patients with different risk stratifications. Results The plasma SCUBE‐1 concentration levels in patients with CTPA confirmed PE (14.28 ± 7.74 ng/ml) was significantly higher than those in the suspicious patients (11.11 ± 4.48 ng/ml) and in healthy control (4.40 ± 3.23 ng/ml) ( P < 0.01). ROC curve analysis showed that at the cut‐off of 7.789 ng/ml, SCUBE‐1 has significant diagnostic value in differentiating PE patients from healthy control (AUC = 0.919, sensitivity = 81.25%, specificity = 92.13%), and the performance is more accurate than D‐dimer (cut‐off 273.4 ng/ml, AUC = 0.648, sensitivity = 65.75%, specificity = 67.42%). The combination of D‐dimer with SCUBE‐1 did not further improve the diagnostic value. However, SCUBE‐1 did not show significant diagnostic value in identifying PE among suspicious patients There was no significant difference in SCUBE‐1 level among different risk groups ( P > 0.05). Conclusion We believe that SCUBE‐1 could be a potential coagulation‐related marker for the diagnosis of PE.

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“…This result is consistent with the findings of other similar studies. Table 3 summarizes the results of five studies, [19][20][21][22][23] which documented decreases ranging from 8.7% 22 to 20.1%, 19 consistently showing an increase in the negative predictive value at the expense of a slight reduction in specificity. 20,22,23 The effect is more relevant among those over 80 years of age 20 and appears to be useful in both hospital and outpatient settings.…”

Section: Discussionmentioning

confidence: 99%

Application of the pulmonary embolism rule-out criteria (PERC rule) and age-adjusted D-Dimer in patients undergoing computed tomography pulmonary angiography for diagnosis of pulmonary embolism

et al. 2023

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Background Diagnosis of pulmonary embolism (PE) constitutes a challenge for practitioners. Current practice involves use of pre-test probability prediction rules. Several strategies to optimize this process have been explored. Objectives To explore whether application of the pulmonary embolism rule-out criteria (PERC rule) and age-adjusted D-dimer (DD) would have reduced the number of computed tomography pulmonary angiography (CTPA) examinations performed in patients with suspected PE. Methods A retrospective cross-sectional study of adult patients taken for CTPA under suspicion of PE in 2018 and 2020. The PERC rule and age-adjusted DD were applied. The number of cases without indications for imaging studies was estimated and the operational characteristics for diagnosis of PE were calculated. Results 302 patients were included. PE was diagnosed in 29.8%. Only 27.2% of ‘not probable’ cases according to the Wells criteria had D-dimer assays. Age adjustment would have reduced tomography use by 11.1%, with an AUC of 0.5. The PERC rule would have reduced use by 7%, with an AUC of 0.72. Conclusions Application of age-adjusted D-dimer and the PERC rule to patients taken for CTPA because of suspected PE seems to reduce the number of indications for the procedure.

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

Cited by 6 publications

References 17 publications

Utilization of serum D-dimer assays prior to computed tomography pulmonary angiography scans in the diagnosis of pulmonary embolism among emergency department physicians: a retrospective observational study

Utilization of serum D-dimer assays prior to computed tomography pulmonary angiography scans in the diagnosis of pulmonary embolism among emergency department physicians: a retrospective observational study

The diagnostic potential of plasma SCUBE‐1 concentration for pulmonary embolism: A pilot study

Application of the pulmonary embolism rule-out criteria (PERC rule) and age-adjusted D-Dimer in patients undergoing computed tomography pulmonary angiography for diagnosis of pulmonary embolism

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