Performance of the Wells and Revised Geneva scores for predicting pulmonary embolism

Çalışır, Cüneyt; Yavas, Ulas Savas; Ozkan, I. Ragıp; Alataş, Füsun; Çevik, Arif Alper; Ergün, Nurdan; Şahin, Fezan

doi:10.1097/mej.0b013e328304ae6d

Cited by 28 publications

(24 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…14,15 To our knowledge the present study is the first to validate the utility of the scoring system in inpatients receiving prophylactic anticoagulation. As would be expected, the prevalence of PE in our population was lower than the 9% to 30% that has previously been reported in patients not receiving prophylactic anticoagulation, [8][9][10][11][12][13][14][15] consistent with the 68% to 76% reduction in the risk of deep venous thrombosis that occurs with use of low-dose heparin or low molecular weight heparin. 16 Similar to the findings of Arnason et al 17 a large proportion of this inpatient cohort was classified as PE-likely on the basis of only 3 of the 7 variables-tachycardia, immobility or previous surgery, and the absence of a more likely competing diagnosis.…”

Section: Discussionsupporting

confidence: 69%

“…These findings lead to the conclusion that CTPE studies were performed excessively in this cohort of patients. Previous studies validating the Wells score enrolled combinations of inpatients and outpatients [8][9][10][11][12][13] or outpatients exclusively. 14,15 To our knowledge the present study is the first to validate the utility of the scoring system in inpatients receiving prophylactic anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

“…7 A sequential diagnostic strategy combining the dichotomous Wells rule with a serum d-dimer test has been validated against contrast-enhanced spiral computed tomography (CTPE) on cohorts comprised largely of ambulatory outpatient and emergency room patients. [8][9][10][11][12][13][14][15] This method, however, has never been tested in hospitalized patients who were receiving heparin in doses designed to prevent the development of venous thromboembolism (VTE). The purpose of this study was to evaluate the utility of the modified Wells score to predict the presence or absence of PE in hospitalized patients who were receiving prophylactic heparin.…”

mentioning

confidence: 99%

See 2 more Smart Citations

The modified wells score accurately excludes pulmonary embolus in hospitalized patients receiving heparin prophylaxis

Bahia¹,

Albert²

2011

Journal of Hospital Medicine

View full text Add to dashboard Cite

BACKGROUND:The usefulness of the Wells score has not been assessed in hospitalized patients receiving prophylactic heparin.METHODS:Retrospective, observational study of hospitalized patients receiving prophylactic heparin who underwent contrast‐enhanced chest computed tomography (CT) for a concern of pulmonary embolism (PE) more than 2 days after admission. Patients with contraindications to, or interruptions in, prophylactic heparin were excluded. The modified (eg, dichotomous) Wells score was retrospectively calculated by reviewing each patient's record. Requesting a d‐dimer was taken to mean that alternate diagnoses were of equal or greater likelihood than acute PE.RESULTS:From January 2006 through December 2007, 286 patients met inclusion criteria. Pulmonary embolus diagnosed by CT was present in 20 patients (7%). The sensitivity, specificity, positive and negative predictive values of a Wells score ≥4.0 were 95%, 27%, 9% and 99%, respectively. A d‐dimer was ordered in 70 of the 74 PE‐unlikely cases, was elevated in 67, and falsely positive in all but 1.CONCLUSIONS:The prevalence of PE in hospitalized patients receiving prophylactic heparin is lower than in cohorts from which the Wells prediction criteria were derived and validated. A modified Wells score <4 safely excludes PE in such patients and reduces the need for CT. D‐dimer testing adds nothing to the evaluation. Journal of Hospital Medicine 2011;. © 2011 Society of Hospital Medicine.

show abstract

Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

The modified wells score accurately excludes pulmonary embolus in hospitalized patients receiving heparin prophylaxis

Bahia¹,

Albert²

2011

Journal of Hospital Medicine

View full text Add to dashboard Cite

show abstract

“…Although the findings appear promising, neither of these variables can currently be recommended as a screening tool for pulmonary embolism until larger prospective studies examine their performance either alone or with preexisting rules. 39,40 …”

Section: Discussionmentioning

confidence: 99%

Ambulatory vital signs in the workup of pulmonary embolism using a standardized 3-minute walk test

Amin

Perry

Stiell

et al. 2015

CJEM

View full text Add to dashboard Cite

Objective: Diagnosing pulmonary embolism can be difficult given its highly variable clinical presentation. Our objective was to determine whether a decrease in oxygen saturation or an increase in heart rate while ambulating could be used as an objective tool in the diagnosis of pulmonary embolism. Methods: This was a two-site tertiary-care-centre prospective cohort study that enrolled adult emergency department or thrombosis clinic patients with suspected or newly confirmed pulmonary embolism. Patients were asked to participate in a standardized 3-minute walk test, which assessed ambulatory heart rate and ambulatory oxygen saturation. The primary outcome was pulmonary embolism. Results: We enrolled 114 patients, including 30 with pulmonary embolism (26.3%). A ≥2% absolute decrease in ambulatory oxygen saturation and an ambulatory change in heart rate >10 beats per minute (BPM) were significantly associated with pulmonary embolism. An ambulatory heart rate change of >10 BPM had a sensitivity of 96.6% (95% confidence interval [CI] 83.3 to 99.4) and a specificity of 31.0% (95% CI 22.1 to 45.0) for pulmonary embolism. A ≥2% absolute decrease ambulatory oxygen saturation had a sensitivity of 80.2% (95% CI 62.7 to 90.5) and a specificity of 39.3% (95% CI 29.5 to 50.0) for pulmonary embolism. The combination of both variables yielded a sensitivity of 100.0% (95% CI 87.0 to 100.0) and a specificity of 11.0% (95% CI 6.6 to 21.0). Conclusion: In summary, our study found that an ambulatory heart rate change of >10 BPM or a ≥2% absolute decrease in ambulatory oxygen saturation from baseline during a standardized 3-minute walk test are highly correlated with pulmonary embolism. Although the findings appear promising, neither of these variables can currently be recommended as a screening tool for pulmonary embolism until larger prospective studies examine their performance either alone or with pre-existing rules. RÉSUMÉObjectif: L'embolie pulmonaire peut être difficile à diagnostiquer étant donné son tableau clinique très variable. L'étude visait à déterminer si une diminution du degré de saturation du sang en oxygène ou une augmentation de la fréquence cardiaque en cours de déambulation pouvait servir d'outil objectif de diagnostic de l'embolie pulmonaire. Méthode: Il s'agit d'une étude prospective de cohortes, menée dans deux centres hospitaliers de soins tertiaires, à laquelle ont participé des patients provenant d'un service d'urgence pour adultes et d'un centre de thrombose, chez qui était soupçonnée ou avait été confirmée depuis peu une embolie pulmonaire. L'on a demandé aux patients de participer à une épreuve de marche normalisée de 3 minutes au cours de laquelle étaient évalués la fréquence cardiaque et le degré de saturation du sang en oxygène, en mode ambulatoire. Le principal critère d'évaluation était l'embolie pulmonaire. Résultats: Ont participé à l'étude 114 patients, dont 30 souffraient d'une embolie pulmonaire (26,3 %). Une diminution absolue ≥2 % du degré de saturation du sang en oxygène en cours d...

show abstract

“…Modifikuota Geneva skalė paremta vien objektyviais klinikiniais kriterijais, todėl klinicisto subjektyvumas ir turima klinikinė patirtis neturi įtakos paciento įvertinimui (22). Manyta, kad PATE tikėtinumo nustatymas remiantis modifikuota Geneva skale yra objektyvesnis nei remiantis Wells skale (22), tačiau studijos, lyginusios šias skales tarpusavyje, Wells skalę nustatė esant jautresnę ir specifiškesnę nei modifikuota Geneva skalė (11,(23)(24)(25). Nedaug studijų lygino šių skalių prognostinę vertę diagnozuojant PATE senyvo amžiaus pacientams (23).…”

Section: Rezultatų Aptarimasunclassified

Ūminė Plaučių Arterijos Trombinė Embolija: Wells Ir Modifikuotos Geneva Skalių Bei D-Dimerų Koncentracijos Prognostinės Vertės Senyvo Amžiaus Pacientams

et al. 2017

View full text Add to dashboard Cite

Raktažodžiai: plaučių arterijos trombinė embolija, Wells skalė, modifikuota Geneva skalė, geriatrija. ĮvadasPlaučių arterijos trombinė embolija (toliau -PATE) -plaučių arterijos arba jos šakų okliuzija trombu, sutrikdanti dalies plaučių parenchimos kraujotaką (1). Tai gyvybei grėsminga patologija, dažniausiai pasireiškianti krūtinės skausmu ir/ar dusuliu, tačiau klinikinė išraiška yra nespecifinė ir gali varijuoti nuo besimptomės iki ryškaus kraujotakos nestabilumo ir mirties (2). PATE diagnostika sudėtinga visų amžiaus grupių pacientams, bet didžiausių diagnostinių sunkumų kelia senyvo amžiaus pacientams (3). Nėra būdingų klinikinių simptomų, fizinio ištyrimo ir laboratorinių tyrimų duomenų, kurie patikimai atmestų plaučių arterijos trombinę emboliją (4). Klinikinį ligonio, kuriam

show abstract

Performance of the Wells and Revised Geneva scores for predicting pulmonary embolism

Abstract: The Wells rule seems to be more accurate among both inpatients and emergency department patients. The Revised Geneva score can be used in emergency department patients with high reliability.

Cited by 28 publications

References 18 publications

The modified wells score accurately excludes pulmonary embolus in hospitalized patients receiving heparin prophylaxis

The modified wells score accurately excludes pulmonary embolus in hospitalized patients receiving heparin prophylaxis

Ambulatory vital signs in the workup of pulmonary embolism using a standardized 3-minute walk test

Ūminė Plaučių Arterijos Trombinė Embolija: Wells Ir Modifikuotos Geneva Skalių Bei D-Dimerų Koncentracijos Prognostinės Vertės Senyvo Amžiaus Pacientams

Contact Info

Product

Resources

About