No added value of the age-adjusted D-dimer cut-off to the YEARS algorithm in patients with suspected pulmonary embolism

L. M. van der Pol; T. van der Hulle; Y. W. Cheung; A. T. A. Mairuhu; C. G. Schaar; L. M. Faber; M. ten Wolde; H. M. A. Hofstee; M. M. C. Hovens; M. Nijkeuter; R. C. J. van Klink; M. J. H. A. Kruip; S. Middeldorp; M. V. Huisman; F. A. Klok

doi:https://doi.org/10.1111/jth.13852

No added value of the age-adjusted D-dimer cut-off to the YEARS algorithm in patients with suspected pulmonary embolism

L. M. van der Pol, T. van der Hulle, Y. W. Cheung, A. T. A. Mairuhu, C. G. Schaar, L. M. Faber, M. ten Wolde, H. M. A. Hofstee, M. M. C. Hovens, M. Nijkeuter, R. C. J. van Klink, M. J. H. A. Kruip, S. Middeldorp, M. V. Huisman, F. A. Klok

Research output: Contribution to journal › Article › Academic › peer-review

10 Citations (Scopus)

Abstract

Background The YEARS algorithm was designed to simplify the diagnostic work-up of pulmonary embolism (PE) and to reduce the number of necessary computed tomography pulmonary angiography (CTPA) scans. An alternative strategy to reduce the number of CTPAs is the age-adjusted D-dimer cut-off (ADJUST) in patients aged 50years or older. We aimed to investigate whether a combination of both diagnostic strategies might save additional CTPAs. Methods The YEARS algorithm consists of three items (clinical signs of deep venous thrombosis, hemoptysis, PE most likely diagnosis') with simultaneous D-dimer testing using a pre-test dependent threshold. We performed a post hoc analysis in 3465 patients managed according to YEARS to compare the number of patients managed without CTPA scans and associated diagnostic failures in hypothetical scenarios with different YEARS-ADJUST combinations. Results Following the YEARS algorithm, 1651 patients (48%) were managed without CTPA; PE was diagnosed in 456 (13%) patients at baseline and 18 patients with initial normal testing suffered venous thromboembolism (VTE) during 3-month follow-up (failure rate 0.61%; 95% confidence interval [CI], 0.36-0.96). If ADJUST had been fully integrated in YEARS, 1627 patients (47%) would have been managed without CTPA (absolute decrease of 0.69%; 95% CI -1.7 to 3.0), at cost of four additional missed PE diagnoses at baseline, for a projected 3-month VTE failure rate of 0.75% (95% CI, 0.49-1.13). None of the other studied scenarios showed relevant improvements in efficiency as well, but all led to more missed diagnoses. Conclusion In our cohort, there was no added value of implementing ADJUST in the YEARS algorithm

Original language	English
Pages (from-to)	2317-2324
Journal	Journal of thrombosis and haemostasis
Volume	15
Issue number	12
Early online date	2017
DOIs	https://doi.org/10.1111/jth.13852
Publication status	Published - 2017

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van der Pol, L. M., van der Hulle, T., Cheung, Y. W., Mairuhu, A. T. A., Schaar, C. G., Faber, L. M., ten Wolde, M., Hofstee, H. M. A., Hovens, M. M. C., Nijkeuter, M., van Klink, R. C. J., Kruip, M. J. H. A., Middeldorp, S., Huisman, M. V., & Klok, F. A. (2017). No added value of the age-adjusted D-dimer cut-off to the YEARS algorithm in patients with suspected pulmonary embolism. Journal of thrombosis and haemostasis, 15(12), 2317-2324. https://doi.org/10.1111/jth.13852

@article{33fbca0ac86841879e966f2db89aa8aa,

title = "No added value of the age-adjusted D-dimer cut-off to the YEARS algorithm in patients with suspected pulmonary embolism",

abstract = "Background The YEARS algorithm was designed to simplify the diagnostic work-up of pulmonary embolism (PE) and to reduce the number of necessary computed tomography pulmonary angiography (CTPA) scans. An alternative strategy to reduce the number of CTPAs is the age-adjusted D-dimer cut-off (ADJUST) in patients aged 50years or older. We aimed to investigate whether a combination of both diagnostic strategies might save additional CTPAs. Methods The YEARS algorithm consists of three items (clinical signs of deep venous thrombosis, hemoptysis, PE most likely diagnosis') with simultaneous D-dimer testing using a pre-test dependent threshold. We performed a post hoc analysis in 3465 patients managed according to YEARS to compare the number of patients managed without CTPA scans and associated diagnostic failures in hypothetical scenarios with different YEARS-ADJUST combinations. Results Following the YEARS algorithm, 1651 patients (48%) were managed without CTPA; PE was diagnosed in 456 (13%) patients at baseline and 18 patients with initial normal testing suffered venous thromboembolism (VTE) during 3-month follow-up (failure rate 0.61%; 95% confidence interval [CI], 0.36-0.96). If ADJUST had been fully integrated in YEARS, 1627 patients (47%) would have been managed without CTPA (absolute decrease of 0.69%; 95% CI -1.7 to 3.0), at cost of four additional missed PE diagnoses at baseline, for a projected 3-month VTE failure rate of 0.75% (95% CI, 0.49-1.13). None of the other studied scenarios showed relevant improvements in efficiency as well, but all led to more missed diagnoses. Conclusion In our cohort, there was no added value of implementing ADJUST in the YEARS algorithm",

author = "{van der Pol}, {L. M.} and {van der Hulle}, T. and Cheung, {Y. W.} and Mairuhu, {A. T. A.} and Schaar, {C. G.} and Faber, {L. M.} and {ten Wolde}, M. and Hofstee, {H. M. A.} and Hovens, {M. M. C.} and M. Nijkeuter and {van Klink}, {R. C. J.} and Kruip, {M. J. H. A.} and S. Middeldorp and Huisman, {M. V.} and Klok, {F. A.}",

year = "2017",

doi = "https://doi.org/10.1111/jth.13852",

language = "English",

volume = "15",

pages = "2317--2324",

journal = "Journal of thrombosis and haemostasis",

issn = "1538-7933",

publisher = "Wiley-Blackwell",

number = "12",

}

van der Pol, LM, van der Hulle, T, Cheung, YW, Mairuhu, ATA, Schaar, CG, Faber, LM, ten Wolde, M, Hofstee, HMA, Hovens, MMC, Nijkeuter, M, van Klink, RCJ, Kruip, MJHA, Middeldorp, S, Huisman, MV & Klok, FA 2017, 'No added value of the age-adjusted D-dimer cut-off to the YEARS algorithm in patients with suspected pulmonary embolism', Journal of thrombosis and haemostasis, vol. 15, no. 12, pp. 2317-2324. https://doi.org/10.1111/jth.13852

TY - JOUR

T1 - No added value of the age-adjusted D-dimer cut-off to the YEARS algorithm in patients with suspected pulmonary embolism

AU - van der Pol, L. M.

AU - van der Hulle, T.

AU - Cheung, Y. W.

AU - Mairuhu, A. T. A.

AU - Schaar, C. G.

AU - Faber, L. M.

AU - ten Wolde, M.

AU - Hofstee, H. M. A.

AU - Hovens, M. M. C.

AU - Nijkeuter, M.

AU - van Klink, R. C. J.

AU - Kruip, M. J. H. A.

AU - Middeldorp, S.

AU - Huisman, M. V.

AU - Klok, F. A.

PY - 2017

Y1 - 2017

N2 - Background The YEARS algorithm was designed to simplify the diagnostic work-up of pulmonary embolism (PE) and to reduce the number of necessary computed tomography pulmonary angiography (CTPA) scans. An alternative strategy to reduce the number of CTPAs is the age-adjusted D-dimer cut-off (ADJUST) in patients aged 50years or older. We aimed to investigate whether a combination of both diagnostic strategies might save additional CTPAs. Methods The YEARS algorithm consists of three items (clinical signs of deep venous thrombosis, hemoptysis, PE most likely diagnosis') with simultaneous D-dimer testing using a pre-test dependent threshold. We performed a post hoc analysis in 3465 patients managed according to YEARS to compare the number of patients managed without CTPA scans and associated diagnostic failures in hypothetical scenarios with different YEARS-ADJUST combinations. Results Following the YEARS algorithm, 1651 patients (48%) were managed without CTPA; PE was diagnosed in 456 (13%) patients at baseline and 18 patients with initial normal testing suffered venous thromboembolism (VTE) during 3-month follow-up (failure rate 0.61%; 95% confidence interval [CI], 0.36-0.96). If ADJUST had been fully integrated in YEARS, 1627 patients (47%) would have been managed without CTPA (absolute decrease of 0.69%; 95% CI -1.7 to 3.0), at cost of four additional missed PE diagnoses at baseline, for a projected 3-month VTE failure rate of 0.75% (95% CI, 0.49-1.13). None of the other studied scenarios showed relevant improvements in efficiency as well, but all led to more missed diagnoses. Conclusion In our cohort, there was no added value of implementing ADJUST in the YEARS algorithm

AB - Background The YEARS algorithm was designed to simplify the diagnostic work-up of pulmonary embolism (PE) and to reduce the number of necessary computed tomography pulmonary angiography (CTPA) scans. An alternative strategy to reduce the number of CTPAs is the age-adjusted D-dimer cut-off (ADJUST) in patients aged 50years or older. We aimed to investigate whether a combination of both diagnostic strategies might save additional CTPAs. Methods The YEARS algorithm consists of three items (clinical signs of deep venous thrombosis, hemoptysis, PE most likely diagnosis') with simultaneous D-dimer testing using a pre-test dependent threshold. We performed a post hoc analysis in 3465 patients managed according to YEARS to compare the number of patients managed without CTPA scans and associated diagnostic failures in hypothetical scenarios with different YEARS-ADJUST combinations. Results Following the YEARS algorithm, 1651 patients (48%) were managed without CTPA; PE was diagnosed in 456 (13%) patients at baseline and 18 patients with initial normal testing suffered venous thromboembolism (VTE) during 3-month follow-up (failure rate 0.61%; 95% confidence interval [CI], 0.36-0.96). If ADJUST had been fully integrated in YEARS, 1627 patients (47%) would have been managed without CTPA (absolute decrease of 0.69%; 95% CI -1.7 to 3.0), at cost of four additional missed PE diagnoses at baseline, for a projected 3-month VTE failure rate of 0.75% (95% CI, 0.49-1.13). None of the other studied scenarios showed relevant improvements in efficiency as well, but all led to more missed diagnoses. Conclusion In our cohort, there was no added value of implementing ADJUST in the YEARS algorithm

U2 - https://doi.org/10.1111/jth.13852

DO - https://doi.org/10.1111/jth.13852

M3 - Article

C2 - 28941051

SN - 1538-7933

VL - 15

SP - 2317

EP - 2324

JO - Journal of thrombosis and haemostasis

JF - Journal of thrombosis and haemostasis

IS - 12

ER -