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Age-Adjusted D-dimer Cutoff for Reducing CT Pulmonary Angiography Tests in Elderly Patients With Suspected Pulmonary EmbolismAge-Adjusted D-dimer Cutoff for Pulmonary Embolism: Improvement or Restoration Back to Normal?

Geert-Jan Geersing, MD, PhD
Author and Funding Information

From the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht.

CORRESPONDENCE TO: Geert-Jan Geersing, MD, PhD, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands; e-mail: g.j.geersing@umcutrecht.nl


FINANCIAL/NONFINANCIAL DISCLOSURES: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(6):1423-1424. doi:10.1378/chest.14-1249
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In a famous paper from the late 1970s, Robin1 postulated his concerns about overdiagnosis and overtreatment of pulmonary embolism (PE), stating that “the emperor of embolism may have no clothes.” He was mainly concerned about overdiagnosing PE in previously healthy young women, arguing that the prior probability of PE is low in these patients, and this subsequently results in a lower positive predictive value of perfusion scans (following Bayes’ theorem). Today, concerns about overdiagnosing PE still remain highly relevant.2 However, in addition to concerns about overdiagnosing PE in young adults, current research also focuses on referring (thus, also overdiagnosing) frail elderly patients too often or too soon for suspected PE: The naked emperor of embolism is aging. The main reason behind this problem comes from the fact that D-dimer testing yields more false-positive results in the elderly as compared with a non-aged population. Thus, many patients need to be referred, and typically only 10% to 15% of these patients have confirmed PE. The use of an age-adjusted cutoff for D-dimer testing (age × 10 in those aged > 50 years) has been proposed, aiming to reduce this number of false-positive results and, thus, the number of patients for whom imaging (CT pulmonary angiography [CTPA]) is required to confirm or refute the diagnosis.3

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