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

Autor:	Stein CE; Jeroen Bosch Ziekenhuis-Geriatrics, Den Bosch, Noord-Brabant, Netherlands., Keijsers CJ; Jeroen Bosch Ziekenhuis-Geriatrics, Den Bosch, Noord-Brabant, Netherlands., Bootsma JE; Jeroen Bosch Ziekenhuis-Geriatrics, Den Bosch, Noord-Brabant, Netherlands., Schouten HJ; Diakonessenhuis Utrecht Zeist Doorn-Geriatrics, Utrecht, Netherlands.
Jazyk:	angličtina
Zdroj:	Age and ageing [Age Ageing] 2016 Nov; Vol. 45 (6), pp. 910-911. Date of Electronic Publication: 2016 Jul 26.
DOI:	10.1093/ageing/afw132
Abstrakt:	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. (© The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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