Multi-center implementation of automated age-adjusted D-dimer results reduces unnecessary PE imaging.

MedStar author(s):
Citation: American Journal of Emergency Medicine. 40:181-183, 2021 02.PMID: 33243536Institution: MedStar Institute for Innovation | MedStar Washington Hospital CenterDepartment: Emergency Medicine | Medical DirectorForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Fibrin Fibrinogen Degradation Products/an [Analysis] | *Pulmonary Embolism/bl [Blood] | *Pulmonary Embolism/dg [Diagnostic Imaging] | Age Factors | Aged | Electronic Health Records | Female | Humans | Male | Middle Aged | Reference Values | Retrospective Studies | Unnecessary ProceduresYear: 2021Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0735-6757
Name of journal: The American journal of emergency medicineAbstract: BACKGROUND: Several previous studies have investigated the clinical utility of age-adjusted D-dimer cutoffs for diagnosing pulmonary embolism (PE).CONCLUSION: Implementation of an automated age-adjusted D-dimer positive reference value reduced CT and V/Q imaging in this population by 4.4% while increasing test accuracy in a regional, heterogeneous six-hospital system. Copyright (c) 2020. Published by Elsevier Inc.METHODS: Retrospective study of all patients who had a D-dimer performed during ED visits between September 2015 to September 2018. On March 21, 2017, the D-dimer upper limit of normal system-wide was increased for patients over 50 to: Age (years) x 0.01mug/mL. D-dimer results were displayed as normal or high based on automated age adjustment. EHR Chart review was performed 1.5 years prior to implementation of age-adjusted D-dimer cutoffs, as well as 1.5 years after to evaluate mortality and test accuracy characteristics such as false negative rates. Comparisons were made using chi-square testing.OBJECTIVES: We performed a pre/post implementation study, using data from a mid-Atlantic healthcare system comprising 6 hospitals and 400,000 ED visits to determine whether implementing age adjusted D-dimer cutoffs reduced the number of imaging tests performed.RESULTS: 22,302 D-dimers were performed pre-implementation of which 10,837 (48.6%) were positive resulting in 7218 (32.3%) imaging studies. After implementation of age-adjusted d-dimer, 25,082 were performed of which 10,851 (43.2%) were positive resulting in 7017 (28.0%) imaging studies. (pre: 48.6%, post: 43.2%; p < 0.01). A significantly lower proportion of patients had a positive d-dimer (pre: 48.6%, post: 43.2%; p < 0.01) and underwent imaging post-implementation (pre: 32.3%, post: 28.0%; p < 0.05) a relative risk reduction of 13.3. This absolute risk reduction of 4.4% is associated with 1104 less scans in the post-implementation group while still increasing test accuracy from 53.7% to 59.2% (p < 0.05).All authors: Davis J, Davis-Allen P, Dubin J, Gillam M, Goyal M, Izzo J, Maloy K, Ratay MK, Wilson MOriginally published: American Journal of Emergency Medicine. 40:181-183, 2021 02.Fiscal year: FY2021Digital Object Identifier: Date added to catalog: 2021-02-18
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 33243536 Available 33243536

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

BACKGROUND: Several previous studies have investigated the clinical utility of age-adjusted D-dimer cutoffs for diagnosing pulmonary embolism (PE).

CONCLUSION: Implementation of an automated age-adjusted D-dimer positive reference value reduced CT and V/Q imaging in this population by 4.4% while increasing test accuracy in a regional, heterogeneous six-hospital system. Copyright (c) 2020. Published by Elsevier Inc.

METHODS: Retrospective study of all patients who had a D-dimer performed during ED visits between September 2015 to September 2018. On March 21, 2017, the D-dimer upper limit of normal system-wide was increased for patients over 50 to: Age (years) x 0.01mug/mL. D-dimer results were displayed as normal or high based on automated age adjustment. EHR Chart review was performed 1.5 years prior to implementation of age-adjusted D-dimer cutoffs, as well as 1.5 years after to evaluate mortality and test accuracy characteristics such as false negative rates. Comparisons were made using chi-square testing.

OBJECTIVES: We performed a pre/post implementation study, using data from a mid-Atlantic healthcare system comprising 6 hospitals and 400,000 ED visits to determine whether implementing age adjusted D-dimer cutoffs reduced the number of imaging tests performed.

RESULTS: 22,302 D-dimers were performed pre-implementation of which 10,837 (48.6%) were positive resulting in 7218 (32.3%) imaging studies. After implementation of age-adjusted d-dimer, 25,082 were performed of which 10,851 (43.2%) were positive resulting in 7017 (28.0%) imaging studies. (pre: 48.6%, post: 43.2%; p < 0.01). A significantly lower proportion of patients had a positive d-dimer (pre: 48.6%, post: 43.2%; p < 0.01) and underwent imaging post-implementation (pre: 32.3%, post: 28.0%; p < 0.05) a relative risk reduction of 13.3. This absolute risk reduction of 4.4% is associated with 1104 less scans in the post-implementation group while still increasing test accuracy from 53.7% to 59.2% (p < 0.05).

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