title: Missed diagnosis of pulmonary embolism with age-adjusted d-dimer cut-off value.
abstract: Pulmonary embolism (PE) is a potentially severe diagnosis with high short-term mortality. Recently, age-adjusted cut-off values (age × 10 μg/l) of D-dimer were introduced to improve the diagnostic workup in older patients. In clinical practice, PE is considered 'ruled out' in patients with a non-high clinical probability and a normal D-dimer. However, all diagnostic tests have a small false-negative rate. This small probability of misdiagnosis might be easily overlooked by clinicians when using simplified dichotomized flow charts. This case illustrates a normal D-dimer (age-adjusted) but with a PE. We recommend clinicians using the D-dimer test-either conventional or age-adjusted in a rule-out strategy to be aware of the-albeit small probability of a false-negative result.
authors: Jeroen Bosch Ziekenhuis-Geriatrics, Den Bosch, Noord-Brabant, Netherlands.
authors: Charlotte Eveline
authors: CE
authors: Stein
authors: Jeroen Bosch Ziekenhuis-Geriatrics, Den Bosch, Noord-Brabant, Netherlands.
authors: Carolina J P W
authors: CJ
authors: Keijsers
authors: Jeroen Bosch Ziekenhuis-Geriatrics, Den Bosch, Noord-Brabant, Netherlands.
authors: Janet E M
authors: JE
authors: Bootsma
authors: Diakonessenhuis Utrecht Zeist Doorn-Geriatrics, Utrecht, Netherlands.
authors: Henrike J
authors: HJ
authors: Schouten
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003951:Diagnostic Errors; D005188:False Negative Reactions; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis*; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: 
  d-dimer; age-adjusted cut-off; older people; pulmonary embolism