Adaptive D-dimer thresholds ruled out pulmonary embolism with a 0.5% miss rate even in the 'adaptive window'

The edition in brief

A meta-analysis of six prospective management studies (12,194 patients) found that when age-adjusted or clinical-probability-adjusted D-dimer thresholds were used to withhold imaging, the three-month failure rate was 0.12% overall and 0.50% (95% CI 0.20–1.11%) in patients whose D-dimer lay between 500 ng/mL and the adaptive threshold, with no heterogeneity. In 10,078 UK adults with severe asthma newly eligible for biologics by exacerbation count, 70% improved to fewer than three exacerbations a year on standard care alone; persistently frequent exacerbators had higher eosinophil counts years earlier. In the Cryo-RCT (627 patients, Asia), cryobiopsy raised histological diagnostic yield for peripheral lesions up to 30 mm from 75% to 83%, at the cost of more moderate bleeding and pneumothorax. In 3,096 people with cystic fibrosis and ABPA, adding antifungals to oral corticosteroids was not associated with better lung function or fewer exacerbations.