Values of the Wells and Revised Geneva Scores Combined with D-dimer in Diagnosing Elderly Pulmonary Embolism Patients

Guo, Danjie; Zhao, Cunyou; Zou, Yadan; Huang, Xu-Hang; Hu, Junfeng; Guo, Lin

doi:10.4103/0366-6999.155085

Cited by 24 publications

(22 citation statements)

References 25 publications

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“…We identified 12 studies [10][11][12][13][14][15][16][18][19][20][21][22] with 3613 patients that met our inclusion criteria for meta-analysis. The detailed steps of our literature search are shown in Fig.…”

Section: Description Of Included Studiesmentioning

confidence: 99%

“…Many studies have investigated the accuracy of these two rules for diagnosis the PE. However, some studies believed the Wells score is more accurate for clinical predicting acute PE than the modified Geneva score [10][11][12], some studies believed the revised Geneva score is equivalent to the Wells rule [13][14][15], while Guo et al believed Wells score is more accurate than the modified Geneva score in nonelderly patients, but not in elderly patients [16]. These conclusions were controversial, and many studies have small sample size.…”

Section: Introductionmentioning

confidence: 99%

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

Shen

Chen

et al. 2015

J Thromb Thrombolysis

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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.

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Section: Description Of Included Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Shen

Chen

et al. 2015

J Thromb Thrombolysis

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“…In a metaanalysis, it was found that Wells score was better than Revised Geneva score in PE exclusion [15]. In another study, Wells score was found to be more successful in detecting PE than Revised Geneva Score in elderly patients; the use of d-dimer test together was shown to increase success rates in two scores [16]. Cheng et al reported that using Wells score with D-dimer test was more successful than Revised Geneva score with D-dimer test to determine the success of PE detection [17].…”

Section: Discussionmentioning

confidence: 98%

Comparison of normal D-dimer in different category in patient with pulmonary embolism

2020

Ann Clin Anal Med

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Aim: Quantitative D-dimer is used to exclude pulmonary embolism in patients with low clinical probability. In this study, we aimed to compare quantitative ddimer, age-adjusted D-dimer, and age-adjusted D-dimer suggested by the American College of Emergency Physicians (ACEP). Materials and Methods: Emergency service patients above the age of 18, whose D-dimer values were tested due to the suspicion of pulmonary thromboembolism were evaluated retrospectively. Quantitative d-dimer level, age-adjusted D-dimer, and age-adjusted D-dimer suggested by the ACEP levels were compared with patient data. SPSS (Statistical Package for Social Sciences) Windows 20.0 software was used for statistical analysis of all data obtained. Results: Three different categories of D-dimer values were compared. According to ACEP, the D-dimer value skipped the least number of PE diagnosis compared to the other values and it was found to be the most significant in determining PE. sPESI was not significant in predicting mortality in PE patients. Discussion: D-Dimer values vary according to the devices and kits used. Today, D-dimer values are used in many clinics to exclude PE. These include the quantitative d-dimer, age-adjusted d-dimer, and the age-adjusted d-dimer suggested by ACEP. It is identified that the cut-off value of d-dimer, calculated according to age, reduced the need for imaging tests significantly compared to quantitative d-dimer. A systemic meta-analysis found that the d-dimer test results calculated for age reduced the need for imaging by 5% compared to normal d-dimer test results when combined with Wells score. Conclusion: Recommended by ACEP age-adjusted D-Dimer may be preferred for the evaluation of pulmonary embolism patients.

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“…48 Besides, research results indicate that in older, high-risk patients, the Wells scores are more in correlation with the diagnosis of PE than the revised Geneva score. [49][50][51] The D-dimer values significantly aided the physicians' decision to refer the patient to further hospital treatment under the diagnosis of PE. When D-dimer values were < 0.5 mg/L, twothirds of patients were not referred for further hospital treatment and the others were referred under some other diagnosis.…”

Section: Discussionmentioning

confidence: 99%

D-dimer: A role in ruling out pulmonary embolism in an emergency care department

Hadžić¹,

Maksimović²,

Stajić³

et al. 2020

Scripta Medica

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Background/Aim: Pulmonary embolism (PE) is a diagnostic challenge, particularly in prehospital care. The aim of this study was to determine to what extent the evaluation of D-dimer value helps physicians with differentiation of PE and whether D-dimer values are in correlation with the values of revised Geneva score. Methods: Data have been collected for the patients whose D-dimer has been evaluated at the Emergency Care Department of the City of Banja Luka in 2018. Gender, age, symptoms, working diagnosis and D-dimer value have all been recorded and also the fact whether the patient was referred to hospital treatment or not. For each patient the revised Geneva score was determined. Results: Sixty-eight tests were done in 2018. Out of 68 tests, 41 were negative (60.3 %). D-dimer results helped in making decisions about referring patients to the hospital or not (χ 2 = 36.32, p < 0.001). Patients with elevated D-dimer levels, especially where the values were four times higher than the refence ones typically were referred to hospital treatment, whereas 67.5% patients with negative D-dimer results were sent home after giving a treatment and advice. In the elderly patients D-dimer was statistically more positive (F = 10.82, p < 0.001). Values of D-dimer were not significantly different regarding gender (χ 2 = 2.19, p = 0.33). According to the results of the revised Geneva score, 5.1 % of patients had high risk of PTE, while moderate and low risk had 47.5 % each. Although it has been found that the values of D-dimer were slightly more elevated at higher values of the revised Geneva score and that the difference was not statistically significant (χ 2 = 7.71, p = 0.10). Conclusion: Values of D-dimer considerably helped in differentiation of PE in the Emergency Care Department. D-dimer has a high negative predictive value and should be used to exclude PE diagnosis for patients with low clinical probability of PE.Key words: D-dimer, pulmonary embolism, revised Geneva score, emergency care department.Pulmonary embolism (PE) is one of the most difficult conditions to diagnose, particularly in the prehospital care. It represents the most serious clinical manifestation of venous thromboembolism (VTE), which represents the third most common cardiovascular disease. [1][2][3][4] The main cause of PE-related deaths is the undiagnosed PE during lifetime (59 %), followed by sudden fatal PE (34 %). It is estimated that only 7 % of patients who died from PE had PE diagnosed on time. 5-7 Frequency of PE is hard to determine because it can sometimes remain asymptomatic and therefore go unsuspected, while on the other hand PE is often accidentally diagnosed as an incidental finding. 8

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Values of the Wells and Revised Geneva Scores Combined with D-dimer in Diagnosing Elderly Pulmonary Embolism Patients

Cited by 24 publications

References 25 publications

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

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

Comparison of normal D-dimer in different category in patient with pulmonary embolism

D-dimer: A role in ruling out pulmonary embolism in an emergency care department

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