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Pulmonary Embolism-Age-Adjusted D-dimer — MRCEM SBA MCQ

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ModerateEmergency MedicinePulmonary Embolism-Age-Adjusted D-dimerMRCEM SBA

A 70-year-old with low pretest probability for PE (Wells score 1.5) has a D-dimer of 600 µg/L FEU. Which is the best next step? (Age 70)

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Correct answer: C — Use age-adjusted D-dimer; PE excluded without imaging

In low/intermediate-risk patients >=50 years, age-adjusted D-dimer (age x 10 µg/L FEU) increases specificity. Threshold is 700 µg/L FEU for this 70-year-old; his 600 µg/L is negative, so imaging is unnecessary. Empiric anticoagulation or imaging is not indicated when the rule-out criteria are met.

Reference: ACEP (2018): Clinical Policy-Suspected Acute Venous Thromboembolic Disease