{ "abstract": "Background\n\nPulmonary embolism (PE) is a common and potentially life-threatening condition encountered in acute medical practice. Computed tomography pulmonary angiography (CTPA) remains the standard imaging modality for diagnosis, but increasing utilisation raises concerns regarding radiation exposure, contrast-related complications, and healthcare resource use. This study evaluated diagnostic pathways for suspected PE through a retrospective clinical audit and practitioner surveys conducted before and after an educational intervention.\n\nMethods\n\nThis study comprised a retrospective clinical audit of 1499 consecutive patients who underwent CTPA for suspected PE, an initial cross-sectional survey of 48 healthcare professionals, and a repeat cross-sectional survey of 33 healthcare professionals conducted after an educational intervention. Collected variables included demographics, Wells score, National Early Warning Score 2 (NEWS2), oxygen saturation, heart rate, D-dimer results, CTPA findings, alternative diagnoses, and in-hospital mortality. The practitioner surveys assessed knowledge of D-dimer testing, use of age-adjusted thresholds, and factors influencing clinical decision-making. Of 1499 CTPA episodes, 1150 had an interpretable D-dimer result. Eight episodes without a definitive CTPA reference-standard outcome were excluded, leaving 1142 episodes for the diagnostic-performance analysis.\n\nResults\n\nPE was confirmed in 206 of 1499 patients, giving an overall prevalence of 13.7%. Among 1142 episodes included in the diagnostic-performance analysis, the standard threshold demonstrated a sensitivity of 87.8% (95% CI 82.3%-91.7%) and specificity of 14.8% (95% CI 12.7%-17.2%). The age-adjusted threshold demonstrated a sensitivity of 86.2% (95% CI 80.5%-90.4%) and specificity of 23.4% (95% CI 20.8%-26.2%). False-positive classifications decreased from 813 to 731, an absolute reduction of 82 cases and a relative reduction of 10.1%, while false-negative classifications increased from 23 to 26.\n\nThe initial practitioner survey identified important knowledge gaps. Age-adjusted D-dimer was used regularly by 21 (44%) of respondents and occasionally by 13 (27%), while six (12%) were unfamiliar with the concept. Following the educational intervention, regular use increased to 18 (54.5%), occasional use was reported by eight (24.2%), and unfamiliarity decreased to approximately one (3%). Awareness of the local D-dimer assay also improved.\n\nClinical decision-making was influenced by fear of missing PE in 32/48 (66.7%) of respondents, while 24/48 (50.0%) reported that clinical impression could outweigh formal scoring systems. In the initial survey, 29/48 respondents (60.4%) were unsure which D-dimer assay was used locally.\n\nConclusions\n\nRetrospective application of the age-adjusted threshold in this CTPA-selected cohort increased specificity and reduced false-positive classifications, with a small reduction in sensitivity and three additional false-negative classifications. Because the analysis was not restricted to patients with PE-unlikely or non-high pre-test probability and did not assess actual imaging utilisation or follow-up safety, these findings do not establish the safety of age-adjusted D-dimer as a PE rule-out strategy. The repeat practitioner survey demonstrated higher assay knowledge and self-reported use; however, causality cannot be inferred from the unpaired survey design.", "abstract_shown": true, "affiliations": [ "Acute Medicine, Queen Elizabeth Hospital, Birmingham, GBR", "General Internal Medicine, Queen Elizabeth Hospital, Birmingham, GBR", "Diabetes and Endocrinology, Queen Elizabeth Hospital, Birmingham, GBR", "Internal Medicine, Queen Elizabeth Hospital, Birmingham, GBR" ], "article_type": "research article", "arxiv": null, "author_total": 5, "authors": [ { "affs": [ 0 ], "name": "Jinsha Khan Basheer" }, { "affs": [ 1 ], "name": "Akhil Jerry" }, { "affs": [ 2 ], "name": "Jhanvi Sawlani" }, { "affs": [ 3 ], "name": "Maher Mahbub" }, { "affs": [ 2 ], "name": "Abdul M Shafi" } ], "bibtex": "https://research.draconitic.com/paper/dyh5rqce79a86.bib", "cited_by": 0, "doi": "10.7759/cureus.117406", "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13727765/?tool=EBI", "id": "dyh5rqce79a86", "issns": [ "2168-8184" ], "landing_url": "https://europepmc.org/article/PMC/PMC13727765", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Internal Medicine" ], [ "heading", "Quality Improvement" ], [ "heading", "Radiology" ], [ "openalex", "2724|Venous Thromboembolism Diagnosis and Management" ] ], "openalex": "W7218946438", "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13727765/pdf/?tool=EBI", "pmcid": "PMC13727765", "pmid": "42978928", "published": "2026-10-03", "publisher": "Cureus Inc.", "ris": "https://research.draconitic.com/paper/dyh5rqce79a86.ris", "sources": [ { "first_seen": "2026-11-04T15:20:46Z", "native_id": "PMC:PMC13727765", "source": "europepmc", "url": "https://europepmc.org/article/PMC/PMC13727765" }, { "first_seen": "2026-11-06T12:23:35Z", "native_id": "PMC13727765", "source": "pmc", "url": "https://doi.org/10.7759/cureus.117406" } ], "subjects": [ { "field": "medicine", "origin": "heading:Radiology", "subfield": "imaging" } ], "title": "Evaluating Age-Adjusted D-dimer and Clinical Decision-Making in Suspected Pulmonary Embolism: A Retrospective Clinical Audit and Practitioner Survey", "title_text": "Evaluating Age-Adjusted D-dimer and Clinical Decision-Making in Suspected Pulmonary Embolism: A Retrospective Clinical Audit and Practitioner Survey", "type": "peer-reviewed", "updated_at": "2026-11-07T12:20:53Z", "url": "https://research.draconitic.com/paper/dyh5rqce79a86", "venue": "Cureus", "versions": [] }