Multi-center implementation of automated age-adjusted D-dimer results reduces unnecessary PE imaging
Several previous studies have investigated the clinical utility of age-adjusted D-dimer cutoffs for diagnosing pulmonary embolism (PE). We performed a pre/post implementation study, using data from a mid-Atlantic healthcare system comprising 6 hospitals and 400,000 ED visits to determine whether imp...
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| Veröffentlicht in: | The American journal of emergency medicine 2021-02, Vol.40, p.181-183 |
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| creator | Dubin, Jeffrey Ratay, Mary Kathleen Wilson, Matt Davis-Allen, Peter Gillam, Michael Izzo, Joseph Maloy, Kevin Davis, Jonathan Goyal, Munish |
| description | Several previous studies have investigated the clinical utility of age-adjusted D-dimer cutoffs for diagnosing pulmonary embolism (PE).
We performed a pre/post implementation study, using data from a mid-Atlantic healthcare system comprising 6 hospitals and 400,000 ED visits to determine whether implementing age adjusted D-dimer cutoffs reduced the number of imaging tests performed.
Retrospective study of all patients who had a D-dimer performed during ED visits between September 2015 to September 2018. On March 21, 2017, the D-dimer upper limit of normal system-wide was increased for patients over 50 to: Age (years) x 0.01μg/mL. D-dimer results were displayed as normal or high based on automated age adjustment. EHR Chart review was performed 1.5 years prior to implementation of age-adjusted D-dimer cutoffs, as well as 1.5 years after to evaluate mortality and test accuracy characteristics such as false negative rates. Comparisons were made using chi-square testing.
22,302 D-dimers were performed pre-implementation of which 10,837 (48.6%) were positive resulting in 7218 (32.3%) imaging studies. After implementation of age-adjusted d-dimer, 25,082 were performed of which 10,851 (43.2%) were positive resulting in 7017 (28.0%) imaging studies. (pre: 48.6%, post: 43.2%; p |
| doi_str_mv | 10.1016/j.ajem.2020.10.067 |
| format | Article |
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We performed a pre/post implementation study, using data from a mid-Atlantic healthcare system comprising 6 hospitals and 400,000 ED visits to determine whether implementing age adjusted D-dimer cutoffs reduced the number of imaging tests performed.
Retrospective study of all patients who had a D-dimer performed during ED visits between September 2015 to September 2018. On March 21, 2017, the D-dimer upper limit of normal system-wide was increased for patients over 50 to: Age (years) x 0.01μg/mL. D-dimer results were displayed as normal or high based on automated age adjustment. EHR Chart review was performed 1.5 years prior to implementation of age-adjusted D-dimer cutoffs, as well as 1.5 years after to evaluate mortality and test accuracy characteristics such as false negative rates. Comparisons were made using chi-square testing.
22,302 D-dimers were performed pre-implementation of which 10,837 (48.6%) were positive resulting in 7218 (32.3%) imaging studies. After implementation of age-adjusted d-dimer, 25,082 were performed of which 10,851 (43.2%) were positive resulting in 7017 (28.0%) imaging studies. (pre: 48.6%, post: 43.2%; p < 0.01). A significantly lower proportion of patients had a positive d-dimer (pre: 48.6%, post: 43.2%; p < 0.01) and underwent imaging post-implementation (pre: 32.3%, post: 28.0%; p < 0.05) a relative risk reduction of 13.3. This absolute risk reduction of 4.4% is associated with 1104 less scans in the post-implementation group while still increasing test accuracy from 53.7% to 59.2% (p < 0.05).
Implementation of an automated age-adjusted D-dimer positive reference value reduced CT and V/Q imaging in this population by 4.4% while increasing test accuracy in a regional, heterogeneous six-hospital system.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2020.10.067</identifier><identifier>PMID: 33243536</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Accuracy ; Age ; Age Factors ; Age-adjusted d-dimer ; Aged ; Automation ; Computed tomography ; Cost reduction ; Diagnostic tests ; Electronic Health Records ; Embolism ; Emergency medical care ; EMR ; Female ; Fibrin Fibrinogen Degradation Products - analysis ; Humans ; Male ; Medical imaging ; Middle Aged ; Mortality ; Patients ; Pulmonary Embolism - blood ; Pulmonary Embolism - diagnostic imaging ; Pulmonary embolisms ; Reference Values ; Retrospective Studies ; Risk reduction ; Unnecessary Procedures</subject><ispartof>The American journal of emergency medicine, 2021-02, Vol.40, p.181-183</ispartof><rights>2020</rights><rights>Copyright © 2020. Published by Elsevier Inc.</rights><rights>Copyright Elsevier Limited Feb 2021</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-ea3c4432814f63d539b51b2254cba67febe246342e142bd1b058db07fe0d8ac63</citedby><cites>FETCH-LOGICAL-c384t-ea3c4432814f63d539b51b2254cba67febe246342e142bd1b058db07fe0d8ac63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2485501981?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33243536$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dubin, Jeffrey</creatorcontrib><creatorcontrib>Ratay, Mary Kathleen</creatorcontrib><creatorcontrib>Wilson, Matt</creatorcontrib><creatorcontrib>Davis-Allen, Peter</creatorcontrib><creatorcontrib>Gillam, Michael</creatorcontrib><creatorcontrib>Izzo, Joseph</creatorcontrib><creatorcontrib>Maloy, Kevin</creatorcontrib><creatorcontrib>Davis, Jonathan</creatorcontrib><creatorcontrib>Goyal, Munish</creatorcontrib><title>Multi-center implementation of automated age-adjusted D-dimer results reduces unnecessary PE imaging</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>Several previous studies have investigated the clinical utility of age-adjusted D-dimer cutoffs for diagnosing pulmonary embolism (PE).
We performed a pre/post implementation study, using data from a mid-Atlantic healthcare system comprising 6 hospitals and 400,000 ED visits to determine whether implementing age adjusted D-dimer cutoffs reduced the number of imaging tests performed.
Retrospective study of all patients who had a D-dimer performed during ED visits between September 2015 to September 2018. On March 21, 2017, the D-dimer upper limit of normal system-wide was increased for patients over 50 to: Age (years) x 0.01μg/mL. D-dimer results were displayed as normal or high based on automated age adjustment. EHR Chart review was performed 1.5 years prior to implementation of age-adjusted D-dimer cutoffs, as well as 1.5 years after to evaluate mortality and test accuracy characteristics such as false negative rates. Comparisons were made using chi-square testing.
22,302 D-dimers were performed pre-implementation of which 10,837 (48.6%) were positive resulting in 7218 (32.3%) imaging studies. After implementation of age-adjusted d-dimer, 25,082 were performed of which 10,851 (43.2%) were positive resulting in 7017 (28.0%) imaging studies. (pre: 48.6%, post: 43.2%; p < 0.01). A significantly lower proportion of patients had a positive d-dimer (pre: 48.6%, post: 43.2%; p < 0.01) and underwent imaging post-implementation (pre: 32.3%, post: 28.0%; p < 0.05) a relative risk reduction of 13.3. This absolute risk reduction of 4.4% is associated with 1104 less scans in the post-implementation group while still increasing test accuracy from 53.7% to 59.2% (p < 0.05).
Implementation of an automated age-adjusted D-dimer positive reference value reduced CT and V/Q imaging in this population by 4.4% while increasing test accuracy in a regional, heterogeneous six-hospital system.</description><subject>Accuracy</subject><subject>Age</subject><subject>Age Factors</subject><subject>Age-adjusted d-dimer</subject><subject>Aged</subject><subject>Automation</subject><subject>Computed tomography</subject><subject>Cost reduction</subject><subject>Diagnostic tests</subject><subject>Electronic Health Records</subject><subject>Embolism</subject><subject>Emergency medical care</subject><subject>EMR</subject><subject>Female</subject><subject>Fibrin Fibrinogen Degradation Products - analysis</subject><subject>Humans</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Patients</subject><subject>Pulmonary Embolism - blood</subject><subject>Pulmonary Embolism - diagnostic imaging</subject><subject>Pulmonary embolisms</subject><subject>Reference Values</subject><subject>Retrospective Studies</subject><subject>Risk reduction</subject><subject>Unnecessary Procedures</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kTtP7DAQhS0Egr3AH6BAkWhosviZBIkGwd4LEggKqC3Hnqwc5bHYMRL_nokWKChuNfb4O8f2HEJOGF0yyoqLdmla6Jec8rmxpEW5QxZMCZ5XrGS7ZEFLofKiVOUB-RNjSyljUsl9ciAEl0KJYkHcY-omn1sYJgiZ7zcd9Lg2kx-HbGwyk6axNxO4zKwhN65Ncd7c5s73KAgQUR-xumQhZmkYAGs04SN7XqGfWfthfUT2GtNFOP6qh-T17-rl5i5_ePp3f3P9kFtRySkHI6yUgldMNoVwSlzWitWcK2lrU5QN1MBlISQHJnntWE1V5WqKB9RVxhbikJxvfTdhfEsQJ937aKHrzABjihrVSuJVokT07BfajikM-DqkKqUou6wYUnxL2TDGGKDRm4B_Ch-aUT1noFs9Z6DnDOYeZoCi0y_rVPfgfiTfQ0fgagsAzuLdQ9DRehgsOB_ATtqN_n_-nyAcmCg</recordid><startdate>202102</startdate><enddate>202102</enddate><creator>Dubin, Jeffrey</creator><creator>Ratay, Mary Kathleen</creator><creator>Wilson, Matt</creator><creator>Davis-Allen, Peter</creator><creator>Gillam, Michael</creator><creator>Izzo, Joseph</creator><creator>Maloy, Kevin</creator><creator>Davis, Jonathan</creator><creator>Goyal, Munish</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202102</creationdate><title>Multi-center implementation of automated age-adjusted D-dimer results reduces unnecessary PE imaging</title><author>Dubin, Jeffrey ; 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We performed a pre/post implementation study, using data from a mid-Atlantic healthcare system comprising 6 hospitals and 400,000 ED visits to determine whether implementing age adjusted D-dimer cutoffs reduced the number of imaging tests performed.
Retrospective study of all patients who had a D-dimer performed during ED visits between September 2015 to September 2018. On March 21, 2017, the D-dimer upper limit of normal system-wide was increased for patients over 50 to: Age (years) x 0.01μg/mL. D-dimer results were displayed as normal or high based on automated age adjustment. EHR Chart review was performed 1.5 years prior to implementation of age-adjusted D-dimer cutoffs, as well as 1.5 years after to evaluate mortality and test accuracy characteristics such as false negative rates. Comparisons were made using chi-square testing.
22,302 D-dimers were performed pre-implementation of which 10,837 (48.6%) were positive resulting in 7218 (32.3%) imaging studies. After implementation of age-adjusted d-dimer, 25,082 were performed of which 10,851 (43.2%) were positive resulting in 7017 (28.0%) imaging studies. (pre: 48.6%, post: 43.2%; p < 0.01). A significantly lower proportion of patients had a positive d-dimer (pre: 48.6%, post: 43.2%; p < 0.01) and underwent imaging post-implementation (pre: 32.3%, post: 28.0%; p < 0.05) a relative risk reduction of 13.3. This absolute risk reduction of 4.4% is associated with 1104 less scans in the post-implementation group while still increasing test accuracy from 53.7% to 59.2% (p < 0.05).
Implementation of an automated age-adjusted D-dimer positive reference value reduced CT and V/Q imaging in this population by 4.4% while increasing test accuracy in a regional, heterogeneous six-hospital system.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33243536</pmid><doi>10.1016/j.ajem.2020.10.067</doi><tpages>3</tpages></addata></record> |
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| subjects | Accuracy Age Age Factors Age-adjusted d-dimer Aged Automation Computed tomography Cost reduction Diagnostic tests Electronic Health Records Embolism Emergency medical care EMR Female Fibrin Fibrinogen Degradation Products - analysis Humans Male Medical imaging Middle Aged Mortality Patients Pulmonary Embolism - blood Pulmonary Embolism - diagnostic imaging Pulmonary embolisms Reference Values Retrospective Studies Risk reduction Unnecessary Procedures |
| title | Multi-center implementation of automated age-adjusted D-dimer results reduces unnecessary PE imaging |
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