Comparison of the Wells score with the revised Geneva score for assessing suspected pulmonary embolism: a systematic review and meta-analysis

Abstract

The Wells score and the revised Geneva score are two most commonly used clinical rules for excluding pulmonary embolism (PE). In this study, we aimed to assess the diagnostic accuracy of these two rules; we also compared the diagnostic accuracy between them. We searched PubMed and Web of science up to April 2015. Studies assessed Wells score and revised Geneva score for diagnosis suspected PE were included. The summary area under the curve (AUC) and the 95 % confidence interval (CI) were calculated. Eleven studies were included in this meta-analysis. For Wells score, the sensitivity ranged from 63.8 to 79.3 %, and the specificity ranged from 48.8 to 90.0 %. The overall weighted AUC was 0.778 (95 % CI 0.740-0.818; Z = 9.88, P < 0.001). For revised Geneva score, the sensitivity ranged from 55.3 to 73.6 %. The overall weighted AUC was 0.693 (95 % CI 0.653-0.736; Z = 11.96, P < 0.001). 95 % CIs of two AUCs were not overlapped, which indicated Wells score was more accurate than revised Geneva score for predicting PE in suspected patients. Meta-regression showed diagnostic accuracy of these two rules was not related with PE prevalence. Sensitivity analysis by only included prospective studies showed the results were robust. Our results showed the Wells score was more effective than the revised Geneva score in discriminate PE in suspected patients.

Diagnostic Performance of Wells Score Combined With Point‐of‐care Lung and Venous Ultrasound in Suspected Pulmonary Embolism

“…Our study did not consider other validated prediction rules. However, a recent meta‐analysis comparing the Ws to the revised Geneva score demonstrated a superior accuracy of the former . In a meta‐analysis by Lucassen et al., the sensitivity of the dichotomized Ws was close to that obtained in our study, whereas the specificity was superior.…”

Audit on the use of CTPA in pulmonary embolism (PE) diagnosis

“…Wells score is a well-validated test and should be calculated in all patients where PE is a potential diagnosis. Other probability scoring tools such as the revised Geneva score have also been well validated [18]. The British Society clinical probability score although not well validated has the advantage of simplicity [19].…”

Elevated d-dimer cut-off values for computed tomography pulmonary angiography—d-dimer correlates with location of embolism

“…Because of increasing population age, especially in Western countries, diagnosis and treatment of APE has become a major challenge (1). Risk stratification with clinical scoring systems such as Wells score or revised Geneva score is of value, but the sensitivity of 64-79% and 44-74%, respectively; limit their use in ruling out the diagnosis (5). D-dimer, a fibrin degradation product, has a reported sensitivity of 95% and specificity of 36%, and is used to exclude APE in low and medium risk patients (6,7).…”