TY - JOUR
T1 - Diagnostic strategy using a modified clinical decision rule and D-dimer test to rule out pulmonary embolism in elderly in- and outpatients
AU - Söhne, Maaike
AU - Kamphuisen, Pieter W.
AU - van Mierlo, Patricia J. W. B.
AU - Büller, Harry R.
PY - 2005
Y1 - 2005
N2 - Excluding or confirming pulmonary embolism remains a diagnostic challenge. In elderly patients pulmonary embolism is associated with substantial co-morbidity and mortality, and many elderly patients with suspected pulmonary embolism are inpatients. The safety and efficacy of the combination of a clinical probability (CDR) and d-dimer test in excluding pulmonary embolism in this group is unclear. We retrospectively analysed data of two prospective studies of consecutive in-and outpatients with suspected pulmonary embolism. The patients were categorized into three age groups: <65 years, 65-75 years and > 75 years. The sensitivity, negative predictive value and the proportion of patients with the combination of a non-high CDR score according to Wells ( <= 4) and a normal d-dimer result were calculated for each group. In 747 consecutive patients with suspected pulmonary embolism, sensitivity and negative predictive dvalue of a non-high CDR and a normal d-dimer result in outpatients (n=538) of all age categories ( <65 years, 65-75 years and > 75 years) were both 100%. These tests were, however, less reliable for inpatients(n=209), irrespective of their age (sensitivity 91% [CI: 79-98%], negative predictive value 88% [CI: 74-96%]. The proportion of both in-and outpatients > 75 years with a non-high CDR and a normal d-dimer concentration was only 14%, whereas this was 22% in patients 65-75 years and 41% among in-and outpatients <65 years, respectively. In elderly outpatients the combination of a non-high CDR and a normal d-dimer result is a safe strategy to rule out pulmonary embolism. However, in inpatients this algorithm is not reliable to safely exclude pulmonary embolism. In addition, the proportion of patients > 65 years in which this strategy excludes pulmonary embolism is markedly lower compared to younger patients
AB - Excluding or confirming pulmonary embolism remains a diagnostic challenge. In elderly patients pulmonary embolism is associated with substantial co-morbidity and mortality, and many elderly patients with suspected pulmonary embolism are inpatients. The safety and efficacy of the combination of a clinical probability (CDR) and d-dimer test in excluding pulmonary embolism in this group is unclear. We retrospectively analysed data of two prospective studies of consecutive in-and outpatients with suspected pulmonary embolism. The patients were categorized into three age groups: <65 years, 65-75 years and > 75 years. The sensitivity, negative predictive value and the proportion of patients with the combination of a non-high CDR score according to Wells ( <= 4) and a normal d-dimer result were calculated for each group. In 747 consecutive patients with suspected pulmonary embolism, sensitivity and negative predictive dvalue of a non-high CDR and a normal d-dimer result in outpatients (n=538) of all age categories ( <65 years, 65-75 years and > 75 years) were both 100%. These tests were, however, less reliable for inpatients(n=209), irrespective of their age (sensitivity 91% [CI: 79-98%], negative predictive value 88% [CI: 74-96%]. The proportion of both in-and outpatients > 75 years with a non-high CDR and a normal d-dimer concentration was only 14%, whereas this was 22% in patients 65-75 years and 41% among in-and outpatients <65 years, respectively. In elderly outpatients the combination of a non-high CDR and a normal d-dimer result is a safe strategy to rule out pulmonary embolism. However, in inpatients this algorithm is not reliable to safely exclude pulmonary embolism. In addition, the proportion of patients > 65 years in which this strategy excludes pulmonary embolism is markedly lower compared to younger patients
U2 - https://doi.org/10.1160/TH04-11-0753
DO - https://doi.org/10.1160/TH04-11-0753
M3 - Article
C2 - 16113805
SN - 0340-6245
VL - 94
SP - 206
EP - 210
JO - Thrombosis and haemostasis
JF - Thrombosis and haemostasis
IS - 1
ER -