Department of Medicine, Intermountain Medical Center, Murray, UT; Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT.
Department of Medicine, Intermountain Medical Center, Murray, UT; Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT.
Chest. 2014 Dec;146(6):1444-1451. doi: 10.1378/chest.13-2386.
D-dimer levels increase with age, and research has suggested that using an age-adjusted D-dimer threshold may improve diagnostic efficiency without compromising safety. The objective of this study was to assess the safety of using an age-adjusted D-dimer threshold in the workup of patients with suspected pulmonary embolism (PE).
We report the outcomes of 923 patients aged > 50 years presenting to our ED with suspected PE, a calculated Revised Geneva Score (RGS), and a D-dimer test. All patients underwent CT pulmonary angiography (CTPA). We compared the false-negative rate for PE of a conventional D-dimer threshold with an age-adjusted D-dimer threshold and report the proportion of patients for whom an age-adjusted D-dimer threshold would obviate the need for CTPA.
Among 104 patients with a negative conventional D-dimer test result and an RGS ≤ 10, no PE was observed within 90 days (false-negative rate, 0%; 95% CI, 0%-2.8%). Among 273 patients with a negative age-adjusted D-dimer result and an RGS ≤ 10, four PEs were observed within 90 days (false-negative rate, 1.5%; 95% CI, 0.4%-3.7%). We observed an 18.3% (95% CI, 15.9%-21.0%) absolute reduction in the proportion of patients aged > 50 years who would merit CTPA by using an age-adjusted D-dimer threshold compared with a conventional D-dimer threshold.
Use of an age-adjusted D-dimer threshold reduces imaging among patients aged > 50 years with an RGS ≤ 10. Although the adoption of an age-adjusted D-dimer threshold is probably safe, the CIs surrounding the additional 1.5% of PEs missed necessitate prospective study before this practice can be adopted into routine clinical care.
D-二聚体水平随年龄增长而升高，研究表明，使用年龄校正的 D-二聚体阈值可以在不影响安全性的情况下提高诊断效率。本研究旨在评估在疑似肺栓塞（PE）患者的检查中使用年龄校正的 D-二聚体阈值的安全性。
我们报告了 923 名年龄>50 岁的因疑似 PE 就诊于我们急诊科的患者的结局、计算的修订日内瓦评分（RGS）和 D-二聚体检测结果。所有患者均接受 CT 肺动脉造影（CTPA）检查。我们比较了常规 D-二聚体阈值与年龄校正的 D-二聚体阈值的 PE 假阴性率，并报告了需要 CTPA 的患者比例。
在 104 例常规 D-二聚体检测结果阴性且 RGS≤10 的患者中，90 天内未观察到 PE（假阴性率为 0%；95%CI，0%-2.8%）。在 273 例年龄校正的 D-二聚体检测结果阴性且 RGS≤10 的患者中，90 天内观察到 4 例 PE（假阴性率为 1.5%；95%CI，0.4%-3.7%）。与常规 D-二聚体阈值相比，使用年龄校正的 D-二聚体阈值可使年龄>50 岁的患者中需要进行 CTPA 的比例降低 18.3%（95%CI，15.9%-21.0%）。
在 RGS≤10 的年龄>50 岁患者中使用年龄校正的 D-二聚体阈值可减少影像学检查。尽管使用年龄校正的 D-二聚体阈值可能是安全的，但由于错过的 1.5%的 PE 事件的 CIs 需要前瞻性研究，因此在将这种做法纳入常规临床护理之前需要进行前瞻性研究。
