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When age adjusted d-dimer is applied in a community setting, there is diagnostic imaging but sensitivity suffers.
We implemented the age-adjusted d-dimer cut off (10x age) in our official hospital guideline. We have not had any misses (at least that have come to our attention). Since this was an accepted practice backed by the hospital guideline, our docs feel much more comfortable using it than if we didn't have a unified policy supporting the practice. Likewise, we got a trimester-adjusted d-dimer cutoff sanctioned by the hospital guideline and many of us will use that in addition. Our guideline committee consisted of representatives from pulmonology, critical care, cardiology, hospital medicine and emergency medicine. It pays to be the leader of a committee which implements guidelines and policy that will ultimately affect you and your departmental colleagues!
What you do matters.