Age-Adjusted D-Dimer in the Evaluation of Venous Thromboembolic Disease

Common Sense - AAEM Member Magazine

Authors: Lee Grodin, MD; Raymond Beyda, MD; Kaycie Corburn, MD; Jacqueline Shibata, MD
Edited By: Jay Khadpe, MD FAAEM and Michael C. Bond, MD FAAEM
Originally Published: November/December 2016 Common Sense

The D-dimer test is an important and widespread tool to assess for venous thromboembolic disease (VTE) in low risk patients. The test has a high sensitivity and negative predictive value; however it is also prone to false positives. Additionally, as D-dimer levels naturally rise with age, the test may lead to more frequent false positives in the elderly than the general population. Recently several investigations examined age related refinements to the interpretation of D-dimer results to rule out VTE. For this month’s resident journal review, we review two retrospective studies and one prospective study that evaluate using age-adjusted D-dimer levels to increase its specificity while retaining its sensitivity. Verification of the results of studies could reduce the use of expensive imaging studies, reduce patient exposure to radiation and contrast, and prevent unnecessary hospital admissions and anticoagulation. These issues are particularly pertinent for the elderly population.

When SCUBA diving goes wrong – Decompression Illness

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Jonathan Morgan, MSIV

This post was peer reviewed.
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Medical Student

Lake Erie College of Osteopathic Medicine-Bradenton

A 54 year-old male presents to your emergency department complaining of dizziness that started shortly after completing a dive. He is a biologist who was studying the nearby river. He reports that about 10 minutes after surfacing he became profoundly dizzy. He also reports nausea that has since resolved. He thinks his hearing is normal. He can walk, but stumbles sideways.

His companions administered oxygen immediately and called 911. He is currently alert, oriented, complaining of only dizziness. His vitals are: BP 130/70, Pulse 76, RR 14, Temp. 37.0 C, SpO2 98% on room air.

What do you need to know about his dive?

Basic information includes maximum depth of the dive, time at maximal depth, decompression or safety stops used, previous dives within 12 hours, and type of gas and equipment used. [1]

Physician Advocacy: Disability Coverage for the EP

Photo Credit: Flickr - Zeevveez

Author: Linda Sanders, MD
Temple University Hospital
Originally Published: Modern Resident February-March 2016

As a new generation of residents prepares to enter private and academic practice as attending emergency physicians, most intend to practice emergency medicine for the next 30 years, maybe more. But in an environment that demands that we have fine motor skills, quick decision making abilities, fast communication and the ability to practice at least eight hours a day, a physical or mental ailment can make one incapable of EM practice. The incidence of disability among practicing physicians is around 2-10%.[2]