Improving diagnostics of pulmonary embolism with clinical prediction models in a clinic of pulmonary diseases
Purpose of the Study: Clinical prediction models have been developed to assess the pre-test probability for pulmonary embolism (PE). The Wells model and the revised Geneva score are the two most well studied. Our purpose was to compare the two prediction models, and indentify the frequent clinical f...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Slovenian Medical Association
2010-10-01
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| Series: | Zdravniški Vestnik |
| Online Access: | http://vestnik.szd.si/index.php/ZdravVest/article/view/310 |
| _version_ | 1819100594858622976 |
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| author | Aleksander Marin Igor Požek Renato Eržen Pika Meško Brguljan Mitja Košnik |
| author_facet | Aleksander Marin Igor Požek Renato Eržen Pika Meško Brguljan Mitja Košnik |
| author_sort | Aleksander Marin |
| collection | DOAJ |
| description | Purpose of the Study: Clinical prediction models
have been developed to assess the pre-test
probability for pulmonary embolism (PE). The
Wells model and the revised Geneva score are
the two most well studied. Our purpose was to
compare the two prediction models, and indentify
the frequent clinical findings of PE in patients
admitted to the University Clinic of Pulmonary
and Allergic Diseases Golnik.
Methods: In 100 random emergency department
patients and hospital inpatients with
suspected PE and performed pulmonary CT
angiography (CTPA) as the gold standard, a retrospective
assessment of the clinical probability
of PE by the Wells rule and the revised Geneva
score was made. ECG, D-dimer, NT-proBNP, arterial
blood gas analysis, chest X-ray, CTPA and
13 other clinical findings were analysed as well.
Results: Average age was 65 years (SD 14.5), 39 %
were male. The overall prevalence of PE was
33 %. The rates of PE in low, moderate, and high
PE risk groups as determined according to the
Wells model and the revised Geneva score were
3.7, 53,1, 100, and 14.3, 32.1, 83.3 %, respectively.
ROC analysis showed that the Wells model was
statistically more accurate than the Geneva score
with the area under the curve (AUC) in Wells
model 0.85 (95 % CI 0.762–0.936) and in Geneva
score 0.73 (95 % CI 0.612–0.838). Sudden
dyspnea, active malignancy, venous thromboembolism
(VTE) history, estrogen therapy, deep
vein thrombosis (DVT) signs, ECG changes and
lower PaCO2 were significantly more frequent in
PE group. All patients with PE had an increased
concentration of D-dimer, and no PE were diagnosed
in the group of patients with normal
D-dimer. CTPA was ordered in 17 % of patients
with low pre-test probability of PE according to
Wells criteria and normal D-dimer. Conclusions: The Wells model is more accurate
than the Geneva scoring system for the diagnosis
of PE in patients admitted to a pulmonary
clinic. Additional findings, such as sudden dyspnea,
estrogen therapy, ECG changes and lower
PaCO2, should always be incorporated in clinical
assessment of PE. Adding the Wells algorithm to
the clinical pathway for PE management might
slightly decrease the number of CTPA. |
| first_indexed | 2024-12-22T01:05:16Z |
| format | Article |
| id | doaj.art-473ded069d694bb7a3919ba5dd3b64c1 |
| institution | Directory Open Access Journal |
| issn | 1318-0347 1581-0224 |
| language | English |
| last_indexed | 2024-12-22T01:05:16Z |
| publishDate | 2010-10-01 |
| publisher | Slovenian Medical Association |
| record_format | Article |
| series | Zdravniški Vestnik |
| spelling | doaj.art-473ded069d694bb7a3919ba5dd3b64c12022-12-21T18:44:06ZengSlovenian Medical AssociationZdravniški Vestnik1318-03471581-02242010-10-017910202Improving diagnostics of pulmonary embolism with clinical prediction models in a clinic of pulmonary diseasesAleksander MarinIgor PožekRenato ErženPika Meško BrguljanMitja KošnikPurpose of the Study: Clinical prediction models have been developed to assess the pre-test probability for pulmonary embolism (PE). The Wells model and the revised Geneva score are the two most well studied. Our purpose was to compare the two prediction models, and indentify the frequent clinical findings of PE in patients admitted to the University Clinic of Pulmonary and Allergic Diseases Golnik. Methods: In 100 random emergency department patients and hospital inpatients with suspected PE and performed pulmonary CT angiography (CTPA) as the gold standard, a retrospective assessment of the clinical probability of PE by the Wells rule and the revised Geneva score was made. ECG, D-dimer, NT-proBNP, arterial blood gas analysis, chest X-ray, CTPA and 13 other clinical findings were analysed as well. Results: Average age was 65 years (SD 14.5), 39 % were male. The overall prevalence of PE was 33 %. The rates of PE in low, moderate, and high PE risk groups as determined according to the Wells model and the revised Geneva score were 3.7, 53,1, 100, and 14.3, 32.1, 83.3 %, respectively. ROC analysis showed that the Wells model was statistically more accurate than the Geneva score with the area under the curve (AUC) in Wells model 0.85 (95 % CI 0.762–0.936) and in Geneva score 0.73 (95 % CI 0.612–0.838). Sudden dyspnea, active malignancy, venous thromboembolism (VTE) history, estrogen therapy, deep vein thrombosis (DVT) signs, ECG changes and lower PaCO2 were significantly more frequent in PE group. All patients with PE had an increased concentration of D-dimer, and no PE were diagnosed in the group of patients with normal D-dimer. CTPA was ordered in 17 % of patients with low pre-test probability of PE according to Wells criteria and normal D-dimer. Conclusions: The Wells model is more accurate than the Geneva scoring system for the diagnosis of PE in patients admitted to a pulmonary clinic. Additional findings, such as sudden dyspnea, estrogen therapy, ECG changes and lower PaCO2, should always be incorporated in clinical assessment of PE. Adding the Wells algorithm to the clinical pathway for PE management might slightly decrease the number of CTPA.http://vestnik.szd.si/index.php/ZdravVest/article/view/310 |
| spellingShingle | Aleksander Marin Igor Požek Renato Eržen Pika Meško Brguljan Mitja Košnik Improving diagnostics of pulmonary embolism with clinical prediction models in a clinic of pulmonary diseases Zdravniški Vestnik |
| title | Improving diagnostics of pulmonary embolism with clinical prediction models in a clinic of pulmonary diseases |
| title_full | Improving diagnostics of pulmonary embolism with clinical prediction models in a clinic of pulmonary diseases |
| title_fullStr | Improving diagnostics of pulmonary embolism with clinical prediction models in a clinic of pulmonary diseases |
| title_full_unstemmed | Improving diagnostics of pulmonary embolism with clinical prediction models in a clinic of pulmonary diseases |
| title_short | Improving diagnostics of pulmonary embolism with clinical prediction models in a clinic of pulmonary diseases |
| title_sort | improving diagnostics of pulmonary embolism with clinical prediction models in a clinic of pulmonary diseases |
| url | http://vestnik.szd.si/index.php/ZdravVest/article/view/310 |
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