title: Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis.
abstract: OBJECTIVE
  To review the diagnostic accuracy of D-dimer testing in older patients (>50 years) with suspected venous thromboembolism, using conventional or age adjusted D-dimer cut-off values.
  
  
  METHODS
  Systematic review and bivariate random effects meta-analysis.
  
  
  METHODS
  We searched Medline and Embase for studies published before 21 June 2012 and we contacted the authors of primary studies.
  
  
  METHODS
  Primary studies that enrolled older patients with suspected venous thromboembolism in whom D-dimer testing, using both conventional (500 µg/L) and age adjusted (age × 10 µg/L) cut-off values, and reference testing were performed. For patients with a non-high clinical probability, 2 × 2 tables were reconstructed and stratified by age category and applied D-dimer cut-off level.
  
  
  RESULTS
  13 cohorts including 12,497 patients with a non-high clinical probability were included in the meta-analysis. The specificity of the conventional cut-off value decreased with increasing age, from 57.6% (95% confidence interval 51.4% to 63.6%) in patients aged 51-60 years to 39.4% (33.5% to 45.6%) in those aged 61-70, 24.5% (20.0% to 29.7% in those aged 71-80, and 14.7% (11.3% to 18.6%) in those aged >80. Age adjusted cut-off values revealed higher specificities over all age categories: 62.3% (56.2% to 68.0%), 49.5% (43.2% to 55.8%), 44.2% (38.0% to 50.5%), and 35.2% (29.4% to 41.5%), respectively. Sensitivities of the age adjusted cut-off remained above 97% in all age categories.
  
  
  CONCLUSIONS
  The application of age adjusted cut-off values for D-dimer tests substantially increases specificity without modifying sensitivity, thereby improving the clinical utility of D-dimer testing in patients aged 50 or more with a non-high clinical probability.
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508GA Utrecht, Netherlands.
authors: Henrike J
authors: HJ
authors: Schouten
authors: G J
authors: GJ
authors: Geersing
authors: H L
authors: HL
authors: Koek
authors: Nicolaas P A
authors: NP
authors: Zuithoff
authors: Kristel J M
authors: KJ
authors: Janssen
authors: Renée A
authors: RA
authors: Douma
authors: Johannes J M
authors: JJ
authors: van Delden
authors: Karel G M
authors: KG
authors: Moons
authors: Johannes B
authors: JB
authors: Reitsma
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011336:Probability; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis*; D012015:Reference Standards; D012680:Sensitivity and Specificity; D054556:Venous Thromboembolism / Q000097:blood / Q000175:diagnosis*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
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