Age-adjusted D-dimer cutoff for reducing CT pulmonary angiography tests in elderly patients with suspected pulmonary embolism: improvement or restoration back to normal?

In a famous paper from the late 1970s, Robin 1 postulated his concerns about overdiagnosis and overtreatment of pulmonary embolism (PE), stating that “the emperor of embolism may have no clothes.” He was mainly concerned about overdiagnosing PE in previously healthy young women, arguing that the prior probability of PE is low in these patients, and this subsequently results in a lower positive predictive value of perfusion scans (following Bayes’ theorem). Today, concerns about overdiagnosing PE still remain highly relevant. 2 However, in addition to concerns about overdiagnosing PE in young adults, current research also focuses on referring (thus, also overdiagnosing) frail elderly patients too oft en or too soon for suspected PE: Th e naked emperor of embolism is aging. Th e main reason behind this problem comes from the fact that D-dimer testing yields more false-positive results in the elderly as compared with a non-aged population. Th us, many patients need to be referred, and typically only 10% to 15% of these patients have confi rmed PE. Th e use of an age-adjusted cutoff for D-dimer testing (age 3 10 in those aged . 50 years) has been proposed, aiming to reduce this number of false-positive results and, thus, the number of patients for whom imaging (CT pulmonary angiography [CTPA]) is required to confi rm or refute the diagnosis. 3