Diagnosis of pulmonary embolism in the elderly: adherence to guidelines and age-adjusted D-dimer concentration values

Lozano-Polo L, Puig-Campmany M, Herrera-Mateo S, Mateo-Roca M, Santos-Rodríguez JA, Benito-Vales S

Objectives.

Methods.

pulmonary arteries justified by suspicion of pulmonary embolism. We analyzed the degree of adherence to CPGs according to age groups, calculated the specificity and sensitivity of combining age-adjusted D-dimer test results and the Wells score, and estimated the number of potentially avoidable CT angiography procedures.

Results.

clinical prediction models were used and patient age (50 years or younger, 69.7%–76.5% adherence; 65–74 years, 32.3%–53.2%; 75–84 years, 29.1%–46.8%; 85–89 years, 32.7%–41.8%; and 90 years or older, 24.4%–46.7%). Adherence was increased when D-dimer test result and the simplified Wells score were combined (increments of 10.4%, 8.0%, 13.6%,

11.1%, respectively in the following age groups: 65–74 years, 75–84 years, 85–89 years, and 90 years or older). Using an ageadjusted D-dimer cut-point increased diagnostic specificity (34.2% without such a cut-point vs 45.8% with one). The positive

predictive value of the test also increased when an age-adjusted D-dimer cut-point was used (to 11.4%, from 9.6% without age adjustement). Seventy CT angiograph procedures (12.5%) could have been avoided by using age-adjusted cut-points.

Conclusions.

Using age-adjusted D-dimer cut-points could decrease the number of pulmonary artery CT angiograms required.

Benito Vales S, Herrera Mateo S, Lozano-Polo L, Mateo Roca M, Puig Campmany M, Santos-Rodríguez JA