Validation of two age dependent D-dimer cut-off values for exclusion of deep vein thrombosis in suspected elderly patients in primary care: retrospective, cross sectional, diagnostic analysis.
OBJECTIVE
To determine whether the use of age adapted D-dimer cut-off values can be translated to primary care patients who are suspected of deep vein thrombosis.


METHODS
Retrospective, cross sectional diagnostic study.


METHODS
110 primary care doctors affiliated with three hospitals in the Netherlands.


METHODS
1374 consecutive patients (936 (68.1%) aged >50 years) with clinically suspected deep vein thrombosis.


METHODS
Proportion of patients with D-dimer values below two proposed age adapted cut-off levels (age in years × 10 μg/L in patients aged >50 years, or 750 μg/L in patients aged ≥ 60 years), in whom deep vein thrombosis could be excluded; and the number of false negative results.


RESULTS
Using the Wells score, 647 patients had an unlikely clinical probability of deep vein thrombosis. In these patients (at all ages), deep vein thrombosis could be excluded in 309 (47.8%) using the age dependent cut-off value compared with 272 (42.0%) using the conventional cut-off value of 500 μg/L (increase 5.7%, 95% confidence interval 4.1% to 7.8%). This exclusion rate resulted in 0.5% and 0.3% false negative cases, respectively (increase 0.2%, 0.004% to 8.6%).The increase in exclusion rate by using the age dependent cut-off value was highest in the oldest patients. In patients older than 80 years, deep vein thrombosis could be safely excluded in 22 (35.5%) patients using the age dependent cut-off value compared with 13 (21.0%) using the conventional cut-off value (increase 14.5%, 6.8% to 25.8%). Compared with the age dependent cut-off value, the cut-off value of 750 μg/L had a similar exclusion rate (307 (47.4%) patients) and false negative rate (0.3%).


CONCLUSIONS
Combined with a low clinical probability of deep vein thrombosis, use of the age dependent D-dimer cut-off value for patients older than 50 years or the cut-off value of 750 μg/L for patients aged 60 years and older resulted in a considerable increase in the proportion of patients in primary care in whom deep vein thrombosis could be safely excluded, compared with the conventional cut-off value of 500 μg/L.
Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands. h.j.schouten-3@umcutrecht.nl
Henrike J
HJ
Schouten
H L Dineke
HL
Koek
Ruud
R
Oudega
Geert-Jan
GJ
Geersing
Kristel J M
KJ
Janssen
Johannes J M
JJ
van Delden
Karel G M
KG
Moons
D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011237:Predictive Value of Tests; D011320:Primary Health Care; D012016:Reference Values; D012189:Retrospective Studies; D020246:Venous Thrombosis / Q000097:blood*
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products