Key result
A combined strategy of clinical probability score and d-dimer safely excluded DVT, but specificity was significantly lower in the oldest quartile compared to the youngest (17.4% vs 49.2%, P<0.000001).
Why the study?
Does the combined strategy of a pretest clinical probability score and d-dimer assay maintain its diagnostic usefulness for deep vein thrombosis in elderly patients?
Observational (n=812)
Does the combined strategy of a pretest clinical probability score and d-dimer assay maintain its diagnostic usefulness for deep vein thrombosis in elderly patients?
Absolute Event Rate: 17.4% vs 49.2%
p-value: p=<0.000001
The combined strategy of a low/moderate clinical probability score and normal d-dimer is safe for excluding DVT in all ages but has significantly reduced specificity and clinical utility in the elderly.
Lower specificity in elderly reduces patients safely ruled out without imaging; leaves open optimization of age-adjusted thresholds.
Summary The combined strategy of a pretest clinical probability (PCP) score and d ‐dimer has shown to be of value in the diagnosis of deep vein thrombosis (DVT). As d ‐dimer concentrations increase with age, the effect of age on the usefulness of this strategy was retrospectively investigated in outpatients suspected of having DVT. In all patients, participants of a prospective management trial, a PCP score and d ‐dimer (Tina‐quant®) were performed. In a total of 812 patients, 317 (39%) had thrombosis. Patients were divided into quartiles according to their age. Sensitivity and negative predictive value of a low/moderate PCP score and a normal d ‐dimer were 98–100% and did not differ between the different age quartiles. Specificity in the highest quartile was 17·4% compared with 49·2% in the youngest ( P < 0·000001). The proportion of patients with a low/moderate PCP score and a normal d ‐dimer decreased with age: 12% in the highest quartile (>73·8 years) versus 25% in younger patients ( P = 0·00005). We therefore conclude that the combined strategy of a low/moderate PCP score with a normal d ‐dimer test is safe for excluding DVT in all age groups, but is less useful in the elderly.
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Schutgens et al. (2005) conducted an observational in suspected deep vein thrombosis (n=812). Combined strategy of a pretest clinical probability score and d-dimer vs. Youngest age quartile was evaluated on Specificity of a low/moderate PCP score and a normal d-dimer (p=<0.000001). A combined strategy of clinical probability score and d-dimer safely excluded DVT, but specificity was significantly lower in the oldest quartile compared to the youngest (17.4% vs 49.2%, P<0.000001).
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