科研之友
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摘要
Study Objective: Validate the sensitivity and specificity of 2 age adjustment strategies for D-dimer values in identifying patients at risk for pulmonary embolism(PE) compared with traditional D-dimer cutoff value (500 ng/mL) to decrease inappropriate computed tomography pulmonary angiography (CTPA) use. Methods: This institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study included all adult emergency department patients evaluated for PE over a 32-month period (1/1/11-8/30/13). Only patients undergoing CTPA and D-dimer testing were included. We used a validated natural language processing algorithm to parse CTPA radiology reports and determine the presence of acute PE. Outcome measures were sensitivity and specificity of 2 age-adjusted D-dimer cutoffs compared with the traditional cutoff. We used chi(2) tests with proportional analyses to assess differences in traditional and age-adjusted (age x 10 ng/mL) D-dimer cutoffs, adjusting both by decade and by year. Results: A total 3063 patients with suspected PE were evaluated by CTPA during the study period, and 1055 (34%) also received D-dimer testing. The specificity of age-adjusted D-dimer values was similar or higher for each age group studied compared with traditional cutoff, without significantly compromising sensitivity. Overall, had decade age-adjusted cutoffs been used, 37 CTPAs could have been avoided (19.6% of 189 patients aged >60 years with Wells score <= 4); had yearly age-adjusted cutoffs been used, 52 CTPAs (18.2% of 286 patients aged >50 years with Wells score <= 4) could have been avoided. Conclusion: Each age-adjusted D-dimer cutoff strategy for the evaluation of PE was associated with increased specificity and statistically insignificant decreased sensitivity when compared with the traditional D-dimer cutoff value.
- 出版日期2014-12
