Abstract
Background
Several previous studies have investigated the clinical utility of age-adjusted D-dimer
cutoffs for diagnosing pulmonary embolism (PE).
Objectives
We performed a pre/post implementation study, using data from a mid-Atlantic healthcare
system comprising 6 hospitals and 400,000 ED visits to determine whether implementing
age adjusted D-dimer cutoffs reduced the number of imaging tests performed.
Methods
Retrospective study of all patients who had a D-dimer performed during ED visits between
September 2015 to September 2018. On March 21, 2017, the D-dimer upper limit of normal
system-wide was increased for patients over 50 to: Age (years) x 0.01μg/mL. D-dimer
results were displayed as normal or high based on automated age adjustment. EHR Chart
review was performed 1.5 years prior to implementation of age-adjusted D-dimer cutoffs,
as well as 1.5 years after to evaluate mortality and test accuracy characteristics
such as false negative rates. Comparisons were made using chi-square testing.
Results
22,302 D-dimers were performed pre-implementation of which 10,837 (48.6%) were positive
resulting in 7218 (32.3%) imaging studies. After implementation of age-adjusted d-dimer,
25,082 were performed of which 10,851 (43.2%) were positive resulting in 7017 (28.0%)
imaging studies. (pre: 48.6%, post: 43.2%; p < 0.01). A significantly lower proportion of patients had a positive d-dimer (pre:
48.6%, post: 43.2%; p < 0.01) and underwent imaging post-implementation (pre: 32.3%, post: 28.0%; p < 0.05) a relative risk reduction of 13.3. This absolute risk reduction of 4.4% is
associated with 1104 less scans in the post-implementation group while still increasing
test accuracy from 53.7% to 59.2% (p < 0.05).
Conclusion
Implementation of an automated age-adjusted D-dimer positive reference value reduced
CT and V/Q imaging in this population by 4.4% while increasing test accuracy in a
regional, heterogeneous six-hospital system.
Keywords
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Article Info
Publication History
Published online: November 02, 2020
Accepted:
October 31,
2020
Received in revised form:
October 26,
2020
Received:
August 3,
2020
Identification
Copyright
© 2020 Published by Elsevier Inc.
