Simplification of the Revised Geneva Score for Assessing Clinical Probability of Pulmonary Embolism

Abstract

Background: The revised Geneva score is a fully standardized clinical decision rule (CDR) in the diagnostic workup of patients with suspected pulmonary embolism (PE). The variables of the decision rule have different weights, which could lead to miscalculations in an acute setting. We have validated a simplified version of the revised Geneva score. Methods: Data from 1049 patients from 2 large prospective diagnostic trials that included patients with suspected PE were used and combined to validate the simplified revised Geneva score. We constructed the simplified CDR by attributing 1 point to each item of the original CDR and compared the diagnostic accuracy of the 2 versions by a receiver operating characteristic curve analysis. We also assessed the clinical utility of the simplified CDR by evaluating the safety of ruling out PE on the basis of the combination of either a low-intermediate clinical probability (using a 3-level scheme) or a "PE unlikely" assessment (using a dichotomized rule) with a normal result on a highly sensitive D-dimer test. Results: The complete study population had an overall prevalence of venous thromboembolism of 23%. The diagnostic accuracy between the 2 CDRs did not differ (area under the curve for the revised Geneva score was 0.75 [95% confidence interval, 0.71-0.78] vs 0.74 [0.70-0.77] for the simplified revised Geneva score). During 3 months of follow-up, no patient with a combination of either a low (0%; 95% confidence interval, 0.0%-1.7%) or intermediate (0%; 0.0%-2.8%) clinical probability, or a "PE unlikely" assessment (0%; 0.0%-1.2%) with the simplified score and a normal result of a D-dimer test was diagnosed as having venous thromboembolism. Conclusion: This study suggests that simplification of the revised Geneva score does not lead to a decrease in diagnostic accuracy and clinical utility, which should be confirmed in a prospective study.

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014).The Task Force of the European Society of Cardiology for diagnosis and management of pulmonary embolism

“…табл. 4) [107,108], и новые версии снова были валидизированы [105,109]. Независимо от варианта прогностических правил, доля больных с подтверж денной ТЭЛА при использовании 3 категорий со ставляет в категории низкой вероятности около 10 %, в категории средней вероятности -30 % и в катего рии высокой вероятности -65 % [104].…”

Diagnosis and Management of Acute Pulmonary Embolism

“…Many of these CPRs have also been modified so as to make them simpler and easier to use in clinical practice, such as modified Wells score 23 , revised Geneva score 24 , and simplified revised Geneva score. 25 The most widely used CPRs are Wells score and the revised Geneva score for suspected PE. Although all scores have been validated in outpatients, only the Wells score has been validated in hospitalized patients.…”

“…Patients with acute PE who die have higher D-dimer levels compared to those who survive. 25,43,44 Acute RV failure is the main cause of death in acute PE, and RV dysfunction on echocardiography is associated with high mortality. 45 A recent meta-analysis has also confirmed this association.…”

“…A strong correlation exists between levels of these markers and RV dysfunction assessed by echocardiography. Patients with acute PE and high levels of BNP and NT-proBNP have a higher mortality or adverse events 25,47 , including even those with normotenisve PE. 46 Elevated values of cardiac troponins T and I are associated with increased risk of short-term mortality in patients with acute PE including those who are hemodynamically stable.…”

Correlation of the Wells and Simplified Revised Geneva Scores with CT Pulmonary Artery Obstruction Index in Pulmonary Embolism

“…However, in order to eliminate this restriction, the Geneva group created and verified a com- pletely standardized objective rule called the Geneva score revised later. It has been recently simplified into the simplified revised Geneva score (11,12).…”