{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T06:02:59Z","timestamp":1784268179733,"version":"3.55.0"},"reference-count":12,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":196,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emergency Medicine International"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Age\u2010adjusted D\u2010dimer (AAD) thresholds are used to reduce false positives in older patients evaluated for pulmonary embolism (PE). However, evidence is limited regarding test behavior near the individualized cutoff (\u201cnear\u2010threshold\u201d zone) and the safety of excluding PE in AAD\u2010negative cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective diagnostic accuracy study of adults \u2265 50\u2009years presenting to a tertiary emergency department (2015\u20132019) with suspected PE who underwent D\u2010dimer testing and definitive imaging (CT pulmonary angiography or V\/Q scintigraphy). Diagnostic performance of the standard threshold (0.5\u2009\u00b5g\/mL, FEU) and AAD (age\u2009\u00d7\u2009 0.01\u2009\u00b5g\/mL) was assessed using ROC analysis. Accuracy metrics are reported with 95% confidence intervals (CIs) via bootstrap; AUC CIs and between\u2010curve comparisons used the DeLong method. The near\u2010threshold zone was defined as \u00b10.1\u2009\u00b5g\/mL around the AAD cutoff. Clinical charts of AAD\u2010negative PE cases were reviewed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 979 patients, 162 (16.5%) had imaging\u2010confirmed PE. Standard D\u2010dimer showed sensitivity 99.4% (95% CI 98.0\u2013100.0) and specificity 4.0% (2.7\u20135.4); AAD showed sensitivity 97.5% (94.8\u201399.4) and specificity 11.8% (9.6\u201313.9). AUCs were 0.734 and 0.727, with no significant difference (DeLong\n                      <jats:italic>p<\/jats:italic>\n                      = 0.41). Within the near\u2010threshold window, PE prevalence was 7.7%, increasing with age (28.6% in \u2265 80\u2009years). Three patients had PE despite AAD\u2010negative results; all had segmental or subsegmental emboli, and no in\u2010hospital complications were documented in the available records.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this imaging\u2010selected retrospective cohort, AAD improved specificity with minimal sensitivity loss. However, AAD should not be used as a stand\u2010alone rule\u2010out strategy and should be applied only within clinical probability\u2010guided diagnostic pathways. Near\u2010threshold results are not risk\u2010free, particularly in older adults, and should prompt careful clinical reassessment when overall probability remains concerning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/emmi\/8353356","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:07:56Z","timestamp":1784264876000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Interpreting Near\u2010Threshold Age\u2010Adjusted D\u2010Dimer for Suspected Pulmonary Embolism in the Emergency Department: A Retrospective Diagnostic Accuracy Study"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5359-6335","authenticated-orcid":false,"given":"Cem","family":"Y\u0131ld\u0131r\u0131m","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0885-8509","authenticated-orcid":false,"given":"Ahmet F\u0131rat","family":"Bekta\u015f","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9653-3236","authenticated-orcid":false,"given":"Ertu\u011f","family":"G\u00fcnsoy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3173-8994","authenticated-orcid":false,"given":"Ahmet","family":"Aykut","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8168-3058","authenticated-orcid":false,"given":"Vedat","family":"K\u0131rpat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3865-8364","authenticated-orcid":false,"given":"Mehmet Veysel","family":"\u00d6nc\u00fcl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"e_1_2_11_1_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz405"},{"key":"e_1_2_11_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2007.03.024"},{"key":"e_1_2_11_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2004.00790.x"},{"key":"e_1_2_11_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-015-1049-7"},{"key":"e_1_2_11_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30597-3"},{"key":"e_1_2_11_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c1475"},{"key":"e_1_2_11_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f2492"},{"key":"e_1_2_11_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD010864.pub2"},{"key":"e_1_2_11_9_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13123441"},{"key":"e_1_2_11_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF03324810"},{"key":"e_1_2_11_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2016.02.043"},{"key":"e_1_2_11_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2015.07.026"}],"container-title":["Emergency 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International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/emmi\/8353356","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/emmi\/8353356","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/emmi\/8353356","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:07:57Z","timestamp":1784264877000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/emmi\/8353356"}},"subtitle":[],"editor":[{"given":"Shashank","family":"Kaushik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":12,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/emmi\/8353356"],"URL":"https:\/\/doi.org\/10.1155\/emmi\/8353356","archive":["Portico"],"relation":{},"ISSN":["2090-2840","2090-2859"],"issn-type":[{"value":"2090-2840","type":"print"},{"value":"2090-2859","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-09-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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