Retrospective Study on the Validity of Age Adjusted D-Dimer

The Trust current guidance for the management of patients with possible Pulmonary Embolism (PE) is that any patient presenting with low probability and a D-Dimer level above 500 µg/L is to be considered as positive and therefore referred for a CT Pulmonary Angiogram (CTPA). Authors need to provide assurance to clinicians and the Trust that by making the change in practice to match the recommended NICE guidance of age adjusted D-Dimer (AAD) that there will be no harm to the patients under the care. This would bring the authors in line with other Trusts across the country and the NCEPOD (National Confidential Enquiry into Patient Outcome and Death) guidance. Other elements to consider are working with the Radiology department to review the implications that the current practice has on radiation exposure. Authors currently refer all patients for a CTPA when there is a raised D-Dimer, if authors were working to AAD then some of these patients would not be referred. The opinion is that this would prevent a radiation exposure, risks associated with the administration of iodinated contrast agents and reduce the number of referrals into radiology, with these factors being considered there is also the potential for reduced bed stay. Due to these factors, there is a potential cost saving for the Trust.