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Comparison of Wells and YEARS clinical decision rules with D‐dimer for low‐risk pulmonary embolus patients
Author(s) -
McLenachan Christopher J.,
Chua Olivia,
Chan Betty S. H.,
Vecellio Elia,
Chiew Angela L.
Publication year - 2019
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.14138
Subject(s) - medicine , d dimer , pulmonary embolism , retrospective cohort study , emergency department , risk stratification , cohort , surgery , pediatrics , psychiatry
Background Assessment of pulmonary embolism (PE) remains a diagnostic and investigative burden to emergency departments. The decision of which D‐dimer cut‐off to use in low‐risk patients remains controversial. Aims To compare the sensitivity and specificity of varying D‐dimer cut‐offs in the diagnosis of PE for Wells low‐risk patients. Methods Retrospective review of patients presenting to a tertiary emergency department over 42 months who had a D‐dimer performed for PE risk stratification. Wells scores were calculated for each patient, those with Wells score of ≤4 (‘PE unlikely’) were analysed. Four D‐dimer thresholds were compared, including traditional threshold (≥0.5 μg/mL), age‐adjusted (≥age in years × 0.01 μg/mL), doubled‐traditional threshold and YEARS criteria. Results During the study period, 2291 D‐dimers were ordered for suspected PE, of which 2125 were low risk for PE. Of these low‐risk patients 46 (2.2%) were found to have a PE. The sensitivity and specificity for each D‐dimer threshold were traditional threshold (95.6% and 65.6%), age‐adjusted (93.5% and 71.7%), doubled traditional (69.6% and 85.5%) and YEARS criteria (80.4% and 84.0%). Utilising an age‐adjusted threshold, YEARS criteria or doubled‐traditional threshold would have resulted in 70, 217 and 245 fewer imaging investigations. Conclusions The prevalence of PE in this low‐risk cohort was very low. Utilising an age‐adjusted D‐dimer would have reduced imaging tests performed while maintaining good sensitivity. Although The YEARS criteria and doubled‐traditional threshold would have reduced scanning considerably both had sensitivities of less than 90%.