scholarly journals Shifting Up Cutoff Value of D-Dimer in the Evaluation of Pulmonary Embolism: A Viable Option? Possible Risks and Benefits

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Bennidor Raviv ◽  
Shlomo H. Israelit
Keyword(s):  
Pulmonary Embolism ◽  
Medical Center ◽  
Age Groups ◽  
Cost Effective ◽  
Patient Characteristics ◽  
Viable Option ◽  
Cutoff Values ◽  
The Subject ◽  
The One ◽  
D Dimer

Objectives.To evaluate the viability of the possibility to use a higher D-dimer value than the one used today in the clinical algorithms evaluating patients suspected to have pulmonary embolism.Methods.A retrospective analysis of 300 serial patients for whom D-dimer values were taken during a 10 month period in the emergency room of a tertiary medical center.Results.Our analysis showed that it may be safe and cost effective to use a D-dimer value of 900 ng/ml rather than the value of 500 ng/ml accepted today, with sensitivity of 94.4%. In younger patients [under 40 years] the sensitivity reached was even higher—100%.Conclusions.Raising cutoff values of D-dimer in screening for pulmonary embolism seems a viable option. There may be a place for “tailoring” cutoff values according individual patient characteristics, such as according age groups. More studies of the subject are warranted.

Children's Empathic Responses to Emotional Complexity

1995 ◽  
Vol 18 (2) ◽  
pp. 211-225 ◽  
Author(s):  
Marcelle Ricard ◽  
Mary Kamberk-Kilicci
Keyword(s):  
Age Groups ◽  
The Subject ◽  
Emotional Complexity ◽  
The One

The aim of this study was to assess the empathic reactivity of children when confronted with two different emotions felt by the same character. A total of 90 girls, divided into three equal groups aged 4, 6, and 8 years, were asked to verbally respond to a series of fictitious stories illustrated by a picture where the character's face was left blank. Four of these episodes implied one simple emotion, and the remaining four were complex episodes where the situation potentially induced two opposite emotions within the character, either successively or simultaneously. Empathy was scored according to (a) the match between the emotion identified in the character and the one reported by the subject, and (b) the interpretation given for the subject's reaction. Both the quality of the match and the level of interpretation from self-to event-to character-centred justifications-were found to increase with age, for complex as well as for simple emotions. However, children of all three age-groups displayed less empathic capabilities when witnessing complex rather than simple episodes, given the more demanding task involved in recognising and sharing emotional complexity. Finally, successive emotions appeared more difficult to cope with than simultaneous emotions, but this decalage may be due to the content of the stimuli used in this study.

scholarly journals Diagnosis of acute Pulmonary Embolism

2018 ◽  
Vol 38 (01) ◽  
pp. 11-21 ◽  
Author(s):  
Helia Robert-Ebadi ◽  
Marc Righini
Keyword(s):  
Pulmonary Embolism ◽  
Cost Effective ◽  
Pulmonary Angiography ◽  
Suspected Pulmonary Embolism ◽  
Computed Tomography Pulmonary Angiography ◽  
Diagnostic Algorithms ◽  
Effective Diagnosis ◽  
Management Algorithms ◽  
Special Patient ◽  
D Dimer

SummaryDuring the last three decades, considerable advances in the management of patients with suspected pulmonary embolism (PE) have improved diagnostic accuracy and made management algorithms safer, easier to use and well standardized. These diagnostic algorithms are mainly based on the assessment of clinical pretest probability, D-Dimer measurement and imaging tests, mainly computed tomography pulmonary angiography (CTPA). These diagnostic algorithms allow a safe and cost-effective diagnosis for most patients with suspected PE.In this review, we discuss current existing evidence for PE diagnosis, the challenge of diagnosing PE in special patient populations, as well as novel imaging tests for PE diagnosis.

scholarly journals NARRATIVE REVIEW ON THE CLINICAL PRACTICE GUIDELINES FOR THE MANAGEMENT OF OVERWEIGHT/OBESITY IN ADULTS

2019 ◽  
pp. 10-16
Author(s):  
PALANISAMY AMIRTHALINGAM
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Age Groups ◽  
Patient Characteristics ◽  
Qualitative Synthesis ◽  
Ethnic Populations ◽  
The Subject

Objectives: Obesity causes morbidity and mortality and also impairs the quality of life in humans. Clinical practice guidelines are well established to treat the obese population with or without comorbidities in all the age groups. Obesity in adults is a risk factor for metabolic disorders including Type-2 diabetes mellitus, hypertension, dyslipidemia, etc. Hence, this review has compared the various international clinical practice guidelines for the management of obesity in adults. Methods: Four articles were included in the qualitative synthesis after the systematic review of the literature obtained from PubMed/MEDLINE and Web of Sciences. Diagnosis and various interventions including lifestyle, pharmacotherapy and bariatric surgery are compared for the management of obesity in adults. Results: The diagnosis is crucial since the criteria to determine overweight/obesity is still under debate due to inconclusive evidence. Various interventions including diet, exercise, behavior, drug therapy, and surgery are being recommended currently for the management of obesity. However, ethnicity and culture play a major role in diagnosis and also interventions. Moreover, personalizing the interventions according to the subject will make sense and offers success in the management of obesity. Conclusion: Diagnosis and the intervention should be subject oriented based on ethnicity, culture and patient characteristics. In this connection, many longitudinal studies warranted to specify the diagnostic and management criteria for adults among the various ethnic populations across the world.

scholarly journals THE RELIABILITY OF CLINICAL PROBABILITY SCORE IN (WELLS SCORE) THE DIAGNOSIS OF PULMONARY EMBOLISM (PE) IN COVID-19 PATIENTS

2021 ◽  
Vol 9 (09) ◽  
pp. 345-349
Author(s):  
Saleh Alkhubaizi ◽  
◽  
Ahmad Al. ALalwi ◽  
Mamdoh Mahboob ◽  
Mohammed Al. Thubity ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Medical Records ◽  
Healthcare Professionals ◽  
Medical Center ◽  
Pulmonary Angiography ◽  
Clinical Probability ◽  
Study Results ◽  
Significant Difference ◽  
Wells Score ◽  
D Dimer

Background: The risk of developing pulmonary embolism (PE) is high in patients infected with COVID-19, and its diagnosis is a severe challenge for healthcare professionals duringthe COVID-19 pandemic. Physicians are frequently usingcomputed tomography pulmonary angiography(CTPA), d-dimer, and well score for the diagnosis of PE. Methods: A retrospective study was used in which we investigated the reliability of clinical well scores by collecting data, such as medical records in registered form (serum D-dimer level and Wells scores) of every patient for whom physicians have requested whose CTPA with suspicion of PE at King Faisal Medical Center (KFMC) from the period from 1st of April to the 1st of October. Results: The study results showed significantly higher values of d-dimer in patients with positive PEcompared to those with negative values. In addition wells score is not a reliable preclinical score in diagnosis PE in COVID 19 patient. Conclusions: As per the results of the well score, there is no significant difference between vulnerable people with PE +ve and -ve.

scholarly journals Age-Adjusted D-Dimer in the Prediction of Pulmonary Embolism: Systematic Review and Meta-analysis

2021 ◽  
Vol 12 ◽  
pp. 215013272110549
Author(s):  
Kenneth Iwuji ◽  
Hasan Almekdash ◽  
Kenneth M. Nugent ◽  
Ebtesam Islam ◽  
Briget Hyde ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
False Positive ◽  
Meta Analysis ◽  
False Positive Rate ◽  
Reference List ◽  
Suspected Pulmonary Embolism ◽  
Clinical Probability ◽  
Cutoff Values ◽  
D Dimer

Background: Pulmonary embolism (PE), depending on the severity, carries a high mortality and morbidity. Proper evaluation, especially in patients with low probability for PE, is important to avoid unnecessary diagnostic testing. Objective: To review the diagnostic utility of conventional versus age-adjusted D-dimer cutoff values in patients 50 years and older with suspected pulmonary embolism. Methods: Systematic review with univariant and bivariant meta-analysis. Data sources: We searched PubMed, MEDLINE, and EBSCO for studies published before September 20th, 2020. We cross checked the reference list of relevant studies that compares conventional versus age-adjusted D-dimer cutoff values in patients with suspected pulmonary embolism. Study selection: We included primary published studies that compared both conventional (500 µg/L) and age-adjusted (age × 10 µg/L) cutoff values in patients with non-high clinical probability for pulmonary embolism. Results: Nine cohorts that included 47 720 patients with non-high clinical probability were included in the meta-analysis. Both Age-adjusted D-dimer and conventional D-dimer have high sensitivity. However, conventional D-dimer has higher false positive rate than age-adjusted D-dimer. Conclusion: Age-adjusted D-dimer cutoffs combined with low risk clinical probability assessment ruled out PE diagnosis in suspected patients with a decreased rate of false positive tests.

Costs and Cost-Effectiveness in Hip and Knee Replacements: A Prospective Study

1997 ◽  
Vol 13 (4) ◽  
pp. 574-588 ◽  
Author(s):  
Pekka Rissanen ◽  
Seppo Aro ◽  
Harri Sintonen ◽  
Kimmo Asikainen ◽  
Pär Slätis ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Total Joint Replacement ◽  
Nottingham Health Profile ◽  
Hospital Costs ◽  
Age Groups ◽  
Cost Effective ◽  
Patient Characteristics ◽  
Related Quality ◽  
Health Related ◽  
A Prospective Study

AbstractThe extensive benefits of the total hip (THA) and knee (TKA) replacements are well documented, but surprisingly little is known about their economics. We assessed costs, cost-effectiveness (C/E), and patient-related C/E variances in THA and TKA from data on 276 THA and 176 TKA patients. Patients with primary arthrosis, primary operation, and total joint replacement were recruited from seven hospitals between March 1991 and June 1992. Their use of health and other welfare services together with health-related quality of life (HRQoL) were measured before the surgery and at 6, 12, and 24 months postoperatively. HRQoL was assessed by the 15D, a 15-dimensional HRQoL instrument, and the Nottingham Health Profile. Costs were assessed from questionnaire responses, the Finnish Hospital Discharge Register, and Finnish Arthroplasty Register. Total hospital costs per patient were 45,000 FIM (US $10,500) for THA and 49,600 FIM (US $11,500) for TKA. Prosthesis costs comprised 21 % of these costs in THA and 24% in TKA. On average, hip patients gained more in terms of HRQoL, and the operations were more cost-effective. The C/E ratio for younger (« 60 years) knee patients did not differ from those in all age groups of hip patients, whereas TKAs in those over 60 years had a worse C/E ratio compared with all other patient subgroups. It was concluded that allocation efficiency can be improved by considering not only the intervention but also patient characteristics such as age. Indeed, the C/E ratio varied more across age groups of knee patients than between average THA and TKA patients.

scholarly journals Age-Adjusted D-Dimer in the Prediction of Pulmonary Embolism: Does a Normal Age-Adjusted D-Dimer Rule Out PE?

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Jacob Ortiz ◽  
Rabia Saeed ◽  
Christopher Little ◽  
Saul Schaefer
Keyword(s):  
Pulmonary Embolism ◽  
Medical Center ◽  
Decision Rules ◽  
Clinical Decision ◽  
Pulmonary Angiography ◽  
Clinical Decision Rules ◽  
Risk Patients ◽  
D Dimer ◽  
Rule Out

Risk assessment for pulmonary embolism (PE) currently relies on physician judgment, clinical decision rules (CDR), and D-dimer testing. There is still controversy regarding the role of D-dimer testing in low or intermediate risk patients. The objective of the study was to define the role of clinical decision rules and D-dimer testing in patients suspected of having a PE. Records of 894 patients referred for computed tomography pulmonary angiography (CTPA) at a University medical center were analyzed. The clinical decision rules overall had an ROC of approximately 0.70, while signs of DVT had the highest ROC (0.80). A low probability CDR coupled with a negative age-adjusted D-dimer largely excluded PE. The negative predictive value (NPV) of an intermediate CDR was 86–89%, while the addition of a negative D-dimer resulted in NPVs of 94%. Thus, in patients suspected of having a PE, a low or intermediate CDR does not exclude PE; however, in patients with an intermediate CDR, a normal age-adjusted D-dimer increases the NPV.

scholarly journals Predicting pulmonary embolism in patients infected with COVID-19 based on D-dimer levels and days between diagnosis of the infection and D-dimer determination

2021 ◽  
Author(s):  
Ignasi Garcia-Olivé ◽  
Helena Sintes ◽  
Joaquim Radua ◽  
Jordi Deportos ◽  
Isabel Nogueira ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Retrospective Study ◽  
Hospital Admission ◽  
Cross Validation ◽  
Area Under The Curve ◽  
Subsequent Development ◽  
Tertiary Hospital ◽  
The Subject ◽  
D Dimer ◽  
Over Time

This was an observational, retrospective study, conducted at a tertiary hospital. All subjects with PCR-confirmed COVID-19 infection requiring hospital admission at our institution between the months of March and April 2020 were included in the study. We compared D-dimer levels in subjects who went on to develop a PE and those who did not. We then created a model to predict the subsequent development of a PE with the current D-dimer levels of the subject. D-dimer levels changed over time from COVID-19 diagnosis, but were always higher in subjects who went on to develop a PE. Regarding the predictive model created, the area under the curve of the ROC analyses of the cross-validation predictions was 0.72. The risk of pulmonary embolism for the same D-dimer levels varied depending on the number of days elapsed since COVID-19 diagnosis and D-dimer determination. To conclude, D-dimer levels were elevated in subjects with a COVID-19 infection, especially in those with PE. D-dimer levels increased during the first 10 days after the diagnosis of the infection and can be used to predict the risk of PE in COVID-19 subjects.

scholarly journals Role of a new age-adjusted D-dimer cutoff value for preoperative deep venous thrombosis exclusion in elderly patients with hip fractures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Kexin Zhang ◽  
Yanbin Zhu ◽  
Yunxu Tian ◽  
Miao Tian ◽  
Xiuting Li ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Hip Fractures ◽  
Age Groups ◽  
New Age ◽  
Optimal Cutoff ◽  
Predictive Values ◽  
Cutoff Value ◽  
Cutoff Values ◽  
D Dimer

Abstract Objective This study aimed to describe the characteristics of plasma D-dimer level with increasing age and establish a new age-adjusted D-dimer cutoff value for excluding preoperative lower limb deep vein thrombosis (DVT) in elderly patients with hip fractures. Methods This was a retrospective study of elderly patients who presented with acute hip fracture in our institution between June 2016 and June 2019. All patients underwent D-dimer test and duplex ultrasound. Patients were divided into six 5-year-apart age groups. The optimal cutoff value for each group was calculated by using receiver operating characteristic (ROC) curves, whereby the new age-adjusted D-dimer cutoff value was determined. The sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were calculated and compared when different D-dimer cutoff values were applied, i.e., conventional 0.5 mg/L, previously well-established age-adjusted cutoff value (age × 0.01 mg/L) and the new age-adjusted D-dimer cutoff value herein. Results There were 2759 patients included, 887 males and 1872 females, with an average age of 78 years. In total, 280 patients were diagnosed with preoperative DVT. The optimal cutoff values for the six age groups were 0.715 mg/L, 1.17 mg/L, 1.62 mg/L, 1.665 mg/L, 1.69 mg/L and 1.985 mg/L, respectively, and the calculated age-adjusted coefficient was 0.02 mg/L. With this new coefficient applied, the specificity was 61%, clearly higher than those for conventional threshold (0.5 mg/L, 37%) or previously established age-adjusted D-dimer threshold (age × 0.01 mg/L, 22%). In contrast, the sensitivity was lower than that (59% vs 85% or 77%) when D-dimer threshold of 0.5 mg/L or age-adjusted cutoff value (age × 0.01 mg/L) was used. The other indexes as PPV (15%, 11% and 12%) and NPV (93%, 93% and 94%) were comparable when three different D-dimer thresholds were applied. Conclusions We developed a new age-adjusted D-dimer cutoff value (age × 0.02 mg/L) for a specified high-risk population of patients aged 65 years or older with hip fractures, and demonstrated the improved utility of the D-dimer test for exclusion of DVT. This formula can be considered for use in elderly hip fracture patients who meet the applicable standards as preoperative DVT screening, after its validity is confirmed by more well-evidenced studies.

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