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).
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?
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.
Absolute Event Rate: 17.4% vs 49.2%
p-value: p=<0.000001
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 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.
Schutgens et al. (Mon,) conducted a 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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