Missed diagnosis of pulmonary embolism with age-adjusted d-dimer cut-off value

Pulmonary embolism (PE) is a potentially severe diagnosis with high short-term mortality. Recently, age-adjusted cut-off values (age × 10 μg/l) of D-dimer were introduced to improve the diagnostic workup in older patients. In clinical practice, PE is considered 'ruled out' in patients with...

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Bibliographic Details
Published in:Age and ageing 2016-11, Vol.45 (6), p.910-911
Main Authors: Stein, Charlotte Eveline, Keijsers, Carolina J P W, Bootsma, Janet E M, Schouten, Henrike J
Format: Article
Language:English
Subjects:
Age Factors
Aged
Aged patients
Biomarkers - blood
Case studies
Diagnosis
Diagnostic Errors
Elderly patients
False Negative Reactions
Fibrin Fibrinogen Degradation Products - analysis
Health aspects
Humans
Male
Predictive Value of Tests
Pulmonary embolism
Pulmonary Embolism - blood
Pulmonary Embolism - diagnosis
Reproducibility of Results
Tomography, X-Ray Computed
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Summary:Pulmonary embolism (PE) is a potentially severe diagnosis with high short-term mortality. Recently, age-adjusted cut-off values (age × 10 μg/l) of D-dimer were introduced to improve the diagnostic workup in older patients. In clinical practice, PE is considered 'ruled out' in patients with a non-high clinical probability and a normal D-dimer. However, all diagnostic tests have a small false-negative rate. This small probability of misdiagnosis might be easily overlooked by clinicians when using simplified dichotomized flow charts. This case illustrates a normal D-dimer (age-adjusted) but with a PE. We recommend clinicians using the D-dimer test-either conventional or age-adjusted in a rule-out strategy to be aware of the-albeit small probability of a false-negative result.
ISSN:0002-0729
1468-2834
DOI:10.1093/ageing/afw132