ArticleCureus2026
Safety of Age-Adjusted D-dimer in Patients Aged ≥50 Years Undergoing Computed Tomography Pulmonary Angiogram (CTPA) for Suspected Pulmonary Embolism: A Retrospective Cohort Study.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Aims This study aims to assess the safety of age-adjusted D-dimer thresholds (AAT) and their impact on imaging utilisation for pulmonary embolism (PE) rule-out in settings where AAT are not routinely applied. Methods and materials We retrospectively studied patients aged ≥50 years who underwent D-dimer testing (without age adjustment) and computed tomography pulmonary angiogram (CTPA) for suspected PE at two different hospital sites (January 2022 to December 2023). Pre-test probability was recorded using the two-level Wells' score. Age-adjusted thresholds were retrospectively calculated, and sensitivity, specificity, negative predictive value (NPV), and failure rate were determined. False negatives were reviewed in further detail. Results Among 1,135 patients, PE was confirmed in 183 (16.1%). Age-adjusted D-dimer yielded 176 true positives, 7 false negatives, 755 false positives and 197 false negatives. Sensitivity was 96.2%, specificity 20.7% and NPV 96.6%. The failure rate among D-dimer negative patients was 3.4% (95% CI: 1.7-6.8%). False negatives included two subsegmental, three segmental with and without subsegmental elements, two lobar and one chronic embolus; none had right ventricular strain. Implementation of AAT could have avoided 197 CTPAs (17.4%), thereby reducing the imaging department's workload and unnecessary contrast and radiation administration. Conclusion In routine National Health Service (NHS) practice, age-adjusted D-dimer demonstrates high sensitivity and NPV in patients ≥50 years. The 3.4% failure rate was above the 3% benchmark, though all missed emboli were of low clot burden without right ventricular strain. These findings support integrating age-adjusted D-dimer into structured pathways to safely reduce CTPA use and resource burden.
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