STUDY OBJECTIVE: We determine the accuracy of an age-adjusted D-dimer threshold to detect @entity1151 in @entity341 ( @entity341 ) @entity1 older than 50 years and describe current @entity341 practices when evaluating possible @entity1151 . METHODS: This was a retrospective study of @entity341 encounters for suspected @entity1151 from 2008 to 2013. We used structured data to calculate the sensitivity, specificity, negative predictive value, and positive predictive value of different D-dimer thresholds. We describe the incidence of @entity1151 , the proportion of @entity1 receiving imaging concordant with D-dimer levels, and the number of "missed" @entity1151 . These findings were used to estimate @entity1 outcomes based on different D-dimer thresholds. RESULTS: Among 31,094 encounters for suspected @entity1151 , there were 507 @entity1151 diagnoses. The age-adjusted D-dimer threshold was more specific (64% versus 54%) but less sensitive (93% versus 98%) than the standard threshold of 500 ng/dL; 11,999 imaging studies identified 507 @entity1151 (4.2%); of these, 1,323 (10.6%) were performed with a D-dimer result below the standard threshold. Among @entity1 encounters without imaging, 17.6% had D-dimer values above the threshold, including 5 missed @entity1151 . Among @entity1 who received imaging, 10.6% had a negative D-dimer result. Applying an age-adjusted D-dimer threshold to our sample would avert 2,924 low-value imaging tests while resulting in 26 additional cases of missed @entity1151 . CONCLUSION: An age-adjusted D-dimer limit has the potential to reduce chest imaging among older @entity341 @entity1 and is more accurate than a standard threshold of 500 ng/dL. Our findings support the adoption of an age-adjusted D-dimer cutoff in community EDs.

An Age-Adjusted D-dimer Threshold for Emergency Department XXXX With Suspected Pulmonary Embolus: Accuracy and Clinical Implications.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity341 :: ('MESH:D004630', 'Disease') :: ['emergency department', 'ED'] @entity1151 :: ('MESH:D011655', 'Disease') :: ['pulmonary embolism', 'pulmonary embolisms']
@entity1 :: (9606,Species) :: ['Patients']
