OBJECTIVE The aim of this study was to compare the age-dependent diagnostic performance of clinical scores and D-dimer testing to identify patients with suspected pulmonary embolism (PE). METHODS Consecutive patients with suspected PE referred from the emergency department for computed tomography pulmonary angiography (CTPA) were retrospectively evaluated. Diagnostic scores (classic Wells score (WS), modified WS, simplified WS, revised Geneva score (GS), simplified GS, and YEARS score) were calculated from medical records. Results of D-dimer testing were retrieved from the laboratory database. CTPA was the diagnostic reference standard. Four age groups were analyzed (< 50, 50-64, 65-74, and ≥ 75 years). Statistical analysis used receiver operating characteristics as well as uni- and multivariate analyses with calculation of prediction models. The study was IRB approved. RESULTS One thousand consecutive patients were included. Areas under the curve (AUC) and accuracies were superior in patients < 50 years. For the classic WS, the AUC decreased by 11% with the optimal cutoff dropping 1.5 points in patients ≥ 75 years; for D-dimer levels, the optimal cutoff was 900 μg/L higher in both ≥ 65 years groups with a max. decrease of the AUC of 9%. In terms of accuracy, the YEARS score performed best across all groups. Classic WS and D-dimer level showed a significant interaction with patient age in prediction models. CONCLUSION D-dimer measurement and clinical scores perform best in patients < 50 years. The YEARS score performs best across all age groups and is therefore recommended. KEY POINTS • The probability of pulmonary embolism predicted by fibrin fibrinogen degradation products and clinical scores shows the highest accuracy in patients < 50 years. • The probability of pulmonary embolism predicted by the YEARS score shows the highest accuracy in each age group. • Classic Wells score and fibrin fibrinogen degradation products show a significant interaction with patient age in a logistic regression model.

中文翻译：

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临床评分系统和D-二聚体水平的年龄依赖性诊断准确性，通过计算机断层扫描肺血管造影（CTPA）诊断肺栓塞。

目的本研究的目的是比较临床评分和D-二聚体测试的年龄依赖性诊断表现，以鉴定可疑的肺栓塞（PE）患者。方法回顾性分析急诊科转诊的连续性疑似PE患者，以进行计算机体层摄影术肺血管造影（CTPA）。从医疗记录中计算出诊断分数（经典的Wells分数（WS），改良的WS，简化的WS，修订的Geneva分数（GS），简化的GS和YEARS分数）。从实验室数据库检索D-二聚体测试的结果。CTPA是诊断参考标准。分析了四个年龄组（<50、50-64、65-74和≥75岁）。统计分析使用了接收器的工作特性，以及单变量和多变量分析以及预测模型的计算。该研究获得IRB批准。结果包括一千名连续患者。小于50岁的患者的曲线下面积（AUC）和准确性较高。对于经典WS，≥75岁的患者的AUC下降了11％，最佳临界值下降了1.5分；对于D-二聚体水平，在≥65岁的两个组中，最佳截止值均高900μg/ L，最大 AUC降低了9％。在准确性方面，YEARS分数在所有组中均表现最佳。在预测模型中，经典WS和D-二聚体水平显示出与患者年龄的显着相互作用。结论D-二聚体的测量和临床评分在50岁以下患者中表现最好。在所有年龄段，YEARS得分均表现最佳，因此值得推荐。要点•由纤维蛋白纤维蛋白原降解产物和临床评分预测的肺栓塞可能性在＜50岁的患者中显示出最高的准确性。•由YEARS分数预测的肺栓塞概率在每个年龄组中显示出最高的准确性。•经典的威尔斯评分和纤维蛋白纤维蛋白原降解产物在逻辑回归模型中显示出与患者年龄的显着相互作用。