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

 

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Abstract

Purpose: To evaluate the effect of an age-dependent D-Dimer cut-off in patients who underwent a computed tomography pulmonary angiogram (CTPA) for suspected pulmonary embolism (PE)

Material and Methods: Retrospective application of an age-dependent D-dimer cut-off (age/100 in patients aged over 50) in 530 consecutive patients, both in- and outpatients, aged over 18, who underwent CTPA for suspected PE according to the guidelines.

Results: The application of an age-dependent D-dimer cut-off showed a now negative test-result in 17 of 530 patients (3.2 %). The proportion was 4.1 % (17 of 418) in patients aged over 50. None of these 17 cases was diagnosed with PE in CTPA, the false-negative rate was 0 %. The effect could be seen in outpatients (14 of 377 [3.7 %]) as well as in inpatients(3 of 153 [2.0 %]) with no statistically significant difference (p > 0.05).

Conclusion: The application of an age-dependent D-dimer cut-off as part of the guidline-based algorithm for suspected PE reduced the number of necessary CTPA in outpatients as well as in inpatients.

Key points:

• The application of an age-dependent D-dimer cut-off reduces the number of CTPA as part of the diagnostic algorithm in patients suspected for PE

No reduction in diagnostic safety was found

• The age adjustement performed equally in outpatients and inpatients

Citation Format:

• Altmann MM, Wrede CE., Peetz D et al. Age-Dependent D-dimer Cut-off to Avoid Unnecessary CT-Exams for Ruling-out Pulmonary Embolism. Fortschr Röntgenstr 2015; 187: 795 – 800

Zusammenfassung

Ziel: Überprüfung des Effekts einer altersangepassten Anhebung des D-Dimer-Grenzwerts von Patienten, die bei Verdacht auf Lungenarterienembolie (LAE) eine Computertomografie-Untersuchung der Pulmonalgefäße (CTPA) erhielten.

Material und Methoden: Retrospektive Anwendung der altersangepassten Anhebung des D-Dimer-Grenzwerts ab einem Alter von 50 Jahren nach der Formel Lebensalter/100 in mg/l auf 530 Patienten über 18 Jahren, die im Notfallzentrum (n = 377) oder auf der Station (n = 153) behandelt wurden und bei klinischem Verdacht auf eine LAE eine CTPA-Untersuchung erhielten.

Ergebnisse: Die Anwendung des altersangepassten D-Dimer-Grenzwerts ergab bei 17 von 530 Patienten (3,2 %) ein neu negatives Testergebnis. Bezogen auf die über 50-jährigen Patienten lag der Anteil dieser Patienten bei 4,1 % (17 von 418). In keinem der 17 Fälle wurde in der CTPA-Untersuchung eine LAE nachgewiesen; somit lag die Rate der falsch-negativen Testergebnisse bei 0 %. Dabei zeigte sich dieser Effekt gleichermaßen bei Patienten des Notfallzentrums wie bei stationären Patienten (14 von 377 [3,7 %] vs. 3 von 153 [2,0 %], p > 0,05).

Schlussfolgerung: Die Anwendung eines altersangepassten D-Dimer-Grenzwerts im Rahmen des leitliniengerechten Algorithmus bei Verdacht auf LAE reduziert die Zahl an erforderlichen CTPA-Untersuchungen sowohl bei Patienten des Notfallzentrums als auch bei stationären Patienten.

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