1. Age Adjusted D-Dimer in PE Rule Out

 Practice Change: An age adjusted d-dimer cut off for PE evaluation is a safe and effective way to evaluate patients over 50 years old for PEs.  I think we should talk to the lab about changing how we report our negative results and start using this ASAP.

Background: The rule: AGE x 10 = D-dimer Cut Off was derived and validated from 4 prospectively gathered data sets in 5182 patients published in BMJ 2010.

This is the external validation study of this rule.

Age-Adjusted D-Dimer Cutoff Levels to Rule Out Pulmonary Embolism: The ADJUST-PE Study  

– JAMA 2014

Design/Background: Prospective Multicenter Validation study from 19 centers in Europe to evaluate the previously derived Age Adjusted PE rule.

Population: Consecutive Emergency Department patients with concern for PE

Intervention: For patients with clinically suspected PE, initially evaluated as low risk with Geneva or Wells Score and followed with a ddimer +/- CTPA.

Cut off for d-dimer was AGE x 10 for patients over the age of 50.

Patients between 500 and age cut off did NOT get a CT scan and were followed up for outcome at 3 months.

Primary Outcome: Were there any failures in the patients between 500 and the age adjusted cut off at 3 month FU?

Secondary Outcomes: How many patients did not require CT?

Results: 3346 patients included in the study Of those, 817 were low risk and had a d-dimer <500 331 were low risk and had a d-dimer between 500 and their age adjusted cut off. These patients did NOT get a CT.

  • One patient in this group had a non-fatal PE in the next 3 months. (0.3%)


% pts ruled out with d-dimer >500 cut off Age Adjusted Cut off
All Patients 28% 40%

Patients >75 yo



Conclusions: This prospective validation study demonstrates age adjusted d-dimer to be a safe and effective way to rule out patients at low risk for PE.  If I can safely rule these folks out without the added time of a CT scan and the added risk of contrast, it seems like a win for everyone.

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