Strategies compared for ruling out pulmonary embolism


(HealthDay)-A diagnostic strategy for suspicion of pulmonary embolism (PE) using the D-dimer threshold, which depends on the probability of pretesting, according to a systematic review and meta-analysis of individual patient data published online. Shows the highest efficiency and the highest predicted failure rate.In Annual report of internal medicine..

Milou AM Stals, MD and colleagues at the Leiden University Medical Center in the Netherlands, YEARS algorithm to investigate well safety and efficiency, modify Geneva scores, and exclude fixed and adapted D-dimer thresholds and acute PE. Combined. Individual patient data from 20,553 patients were included from 16 studies that evaluated at least one diagnostic strategy.

Researchers have the highest efficiency defined as the percentage of individuals classified as “PE considered excluded” without imaging tests (47-68%) in patients under 40 years of age, and 80 years of age or older. It was found to be the lowest in patients (6.0-23 percent) and among cancer patients (9.6-26 percent). Applying pretested probability-dependent D-dimer thresholds significantly improved efficiency in these subgroups. Strategies using the adapted D-dimer threshold had the highest predicted failure rates, varying at a rate of 2-4% in the predefined patient subgroups.

“In summary, these findings suggest that increasing the D-dimer cutoff may save some patients from x-ray testing, but without introducing the risk of diagnostic failure. There is no way to raise the price, “the author of the accompanying editorial writes.

Age-adjusted D-dimer test improves ability to exclude PE

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