Can an Age-Adjusted D-Dimer be Used to Safely Rule Out Pulmonary Embolism in Emergency Department Patients?

Reviewed and approved by the AAEM Board of Directors (3/20/2017)

Introduction: Pulmonary embolism (PE) is a serious, potentially fatal condition, but is difficult to safely rule out using only clinical features. Studies have demonstrated that a combination of risk-stratification and D-dimer testing can essentially rule-out PE. The prevalence of PE increases with age, but D-dimer levels also increase with age, which lowers D-dimer test specificity and reduces its utility in elderly patients.

We performed a systematic review using the AAEM CPC Statement on Protocols for literature search/grading process to identify articles that could answer the question: Can an age-adjusted D-dimer be used to safely rule-out pulmonary embolism in emergency department patients?

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Reference and Literature Grading (PDF)