Effects of age on the performance of common diagnostic tests for pulmonary embolism

doi:10.1016/S0002-9343(00)00493-9

The American Journal of Medicine

Volume 109, Issue 5, 1 October 2000, Pages 357-361

https://doi.org/10.1016/S0002-9343(00)00493-9 Get rights and content

Abstract

PURPOSE: The diagnosis of pulmonary embolism in the elderly is often difficult because of comorbid medical conditions, and perhaps also because diagnostic tests have a lower yield. We analyzed the diagnostic performance of common diagnostic tests for pulmonary embolism in different age groups.

METHODS: We analyzed data from two large studies that enrolled 1,029 consecutive patients presenting to the emergency department with clinically suspected pulmonary embolism. The clinical probability of pulmonary embolism (high [≥80%], intermediate, or low [≤20%]) was estimated by the treating physician. All patients underwent a sequential diagnostic protocol, including ventilation-perfusion lung scan, measurement of plasma D-dimer level, lower limb venous compression ultrasonography, and pulmonary angiography if the noninvasive work-up was inconclusive.

RESULTS: The prevalence of pulmonary embolism increased progressively, from 12% in patients <40 years of age to 44% in those ≥80 years of age. The positive predictive value of a high clinical probability of pulmonary embolism was greater in the elderly (71% to 78% in those ≥60 years old versus 40% to 64% in those ≤59 years old). The sensitivity of D-dimer testing was 100% in all age groups, but its specificity decreased markedly with age, from 67% in those ≤40 years old to 10% in those ≥80 years old. The diagnostic yield of lower limb compression ultrasonography was greater in the elderly. The proportion of lung scans that were diagnostic (normal, near-normal, or high probability) decreased from 68% to 42% with increasing age.

CONCLUSIONS: Age affects the performance of common diagnostic tests for pulmonary embolism and should be kept in mind when evaluating patients suspected of having this condition.

Section snippets

Patients

One thousand three-hundred and thirteen consecutive patients admitted to the emergency department of the Geneva University Hospital (Geneva, Switzerland) between October 1, 1992, and October 31, 1997, or to the emergency department of the Hôpital Saint-Luc (Montreal, Canada) between November 1, 1996, and October 31, 1997, for clinically suspected pulmonary embolism, were included in two successive studies of the diagnosis of pulmonary embolism 9, 12. Exclusion criteria included suspected

Results

Of the 1,029 patients who were suspected of having a pulmonary embolism, 280 (27%) had a pulmonary embolism. More than half of the patients with pulmonary embolism were 70 years of age or older. Prevalence varied by age, from 12% in the youngest patients to 44% in the oldest (Figure 1).

Discussion

We performed a systematic study of the effects of age on the performance of tests commonly used in patients with suspected pulmonary embolism. First, while confirming the increased prevalence of the disease in patients more than 60 years old, our results demonstrate that age does not strongly influence physicians’ assignment of the clinical probability of pulmonary embolism: approximately 10% of patients were assigned a high clinical probability in all age groups (Table 1). However, age affects

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Conclusion
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Clinical studyEffects of age on the performance of common diagnostic tests for pulmonary embolism

Abstract

Section snippets

Patients

Results

Discussion

Chest

Lancet

Lancet

Pulmonary embolism in the elderly

Age Ageing

The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly

Arch Intern Med

Pulmonary embolism

N Engl J Med

Value of the ventilation/perfusion scan in acute pulmonary embolismresults of the prospective investigation of pulmonary embolism diagnosis

JAMA

Clinical study
Effects of age on the performance of common diagnostic tests for pulmonary embolism