Padua Score and D-dimer for Pulmonary Embolism Exclusion in the Elderly
Purpose: This study was aimed at identifying biomarkers that could help exclude pulmonary embolism (PE) in patients aged 65 years and older, considering age-related challenges such as atypical clinical presentations and the presence of comorbidities. Methods: This single-center cohort study retro...
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Rambam Health Care Campus
2025-07-01
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| Series: | Rambam Maimonides Medical Journal |
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| Online Access: | https://www.rmmj.org.il/issues/67/3274/manuscript |
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| author | Ramon Cohen Shay Nemet Marina A. Fradkin Tal Schiller Alena Kirzhner Haitham Abu Khadija Meital Deitch Daniel Elbirt |
| author_facet | Ramon Cohen Shay Nemet Marina A. Fradkin Tal Schiller Alena Kirzhner Haitham Abu Khadija Meital Deitch Daniel Elbirt |
| author_sort | Ramon Cohen |
| collection | DOAJ |
| description | Purpose: This study was aimed at identifying biomarkers that could help exclude pulmonary embolism (PE) in patients aged 65 years and older, considering age-related challenges such as atypical clinical presentations and the presence of comorbidities.
Methods: This single-center cohort study retrospectively collected data on 28 potential markers from patients aged 65 years and older who underwent computed tomography scans for PE diagnosis in emergency or internal wards over a 2.5-year period.
Results: The study included 157 patients after exclusions, with 35 diagnosed with PE. Patients with PE exhibited higher D-dimer levels, lower platelet counts, and higher Padua scores. Six markers were selected based on likelihood ratio, each with an area under the curve above 0.7 and P-value below 0.05. Multiplying D-dimer levels with the Padua score (PaDd) improved specificity from 9% to 32% while maintaining 100% sensitivity in identifying PE. Further refinement by incorporating activated partial thromboplastin time (aPTT) into the Padua score multiplied by D-dimer (PaDd/aPTT) resulted in improved sensitivity and specificity.
Conclusion: The Padua score multiplied by D-dimer is a simple yet effective tool that enhances specificity while maintaining high sensitivity, potentially reducing computed tomography utilization in elderly patients. Prospective, multicenter studies are needed to validate these findings and integrate them into routine clinical practice. |
| format | Article |
| id | doaj-art-6b24a1f424b14e51a09cafaa86feb7d3 |
| institution | Kabale University |
| issn | 2076-9172 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Rambam Health Care Campus |
| record_format | Article |
| series | Rambam Maimonides Medical Journal |
| spelling | doaj-art-6b24a1f424b14e51a09cafaa86feb7d32025-08-20T03:37:05ZengRambam Health Care CampusRambam Maimonides Medical Journal2076-91722025-07-01163e001310.5041/RMMJ.10548Padua Score and D-dimer for Pulmonary Embolism Exclusion in the ElderlyRamon Cohen0Shay Nemet1Marina A. Fradkin2Tal Schiller3Alena Kirzhner4Haitham Abu Khadija5Meital Deitch6Daniel Elbirt7Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Department of Internal Medicine B, Kaplan Medical Center, Rehovot, Israel; and Department of Clinical Immunology Allergy and AIDS, Kaplan Medical Center, Rehovot, IsraelFaculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; and Department of Clinical Immunology Allergy and AIDS, Kaplan Medical Center, Rehovot, IsraelFaculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; and Department of Radiology, Rabin Medical Center, Petah Tikva, IsraelFaculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel and Department of Diabetes, Endocrinology and Metabolism, Kaplan Medical Center, Rehovot, IsraelFaculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Department of Diabetes, Endocrinology and Metabolism, Kaplan Medical Center, Rehovot, Israel; and Department of Internal Medicine A, Kaplan Medical Center, Rehovot, IsraelFaculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel and Heart Center, Kaplan Medical Center, Rehovot, IsraelFaculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel and Intensive Care Unit, Kaplan Medical Center, Rehovot, IsraelFaculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel and Department of Internal Medicine B, Kaplan Medical Center, Rehovot, IsraelPurpose: This study was aimed at identifying biomarkers that could help exclude pulmonary embolism (PE) in patients aged 65 years and older, considering age-related challenges such as atypical clinical presentations and the presence of comorbidities. Methods: This single-center cohort study retrospectively collected data on 28 potential markers from patients aged 65 years and older who underwent computed tomography scans for PE diagnosis in emergency or internal wards over a 2.5-year period. Results: The study included 157 patients after exclusions, with 35 diagnosed with PE. Patients with PE exhibited higher D-dimer levels, lower platelet counts, and higher Padua scores. Six markers were selected based on likelihood ratio, each with an area under the curve above 0.7 and P-value below 0.05. Multiplying D-dimer levels with the Padua score (PaDd) improved specificity from 9% to 32% while maintaining 100% sensitivity in identifying PE. Further refinement by incorporating activated partial thromboplastin time (aPTT) into the Padua score multiplied by D-dimer (PaDd/aPTT) resulted in improved sensitivity and specificity. Conclusion: The Padua score multiplied by D-dimer is a simple yet effective tool that enhances specificity while maintaining high sensitivity, potentially reducing computed tomography utilization in elderly patients. Prospective, multicenter studies are needed to validate these findings and integrate them into routine clinical practice.https://www.rmmj.org.il/issues/67/3274/manuscriptd-dimerelderlyinflammationpaduapulmonary embolism |
| spellingShingle | Ramon Cohen Shay Nemet Marina A. Fradkin Tal Schiller Alena Kirzhner Haitham Abu Khadija Meital Deitch Daniel Elbirt Padua Score and D-dimer for Pulmonary Embolism Exclusion in the Elderly Rambam Maimonides Medical Journal d-dimer elderly inflammation padua pulmonary embolism |
| title | Padua Score and D-dimer for Pulmonary Embolism Exclusion in the Elderly |
| title_full | Padua Score and D-dimer for Pulmonary Embolism Exclusion in the Elderly |
| title_fullStr | Padua Score and D-dimer for Pulmonary Embolism Exclusion in the Elderly |
| title_full_unstemmed | Padua Score and D-dimer for Pulmonary Embolism Exclusion in the Elderly |
| title_short | Padua Score and D-dimer for Pulmonary Embolism Exclusion in the Elderly |
| title_sort | padua score and d dimer for pulmonary embolism exclusion in the elderly |
| topic | d-dimer elderly inflammation padua pulmonary embolism |
| url | https://www.rmmj.org.il/issues/67/3274/manuscript |
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