Tuberc Respir Dis.  2008 Apr;64(4):266-271. 10.4046/trd.2008.64.4.266.

Assessment of Two Clinical Prediction Models for a Pulmonary Embolism in Patients with a Suspected Pulmonary Embolism

• Park JS
• Choi WI
• Min BR
• Park JH
• Chae JN
• Jeon YJ
• Yu HJ
• Kim JY
• Kim GJ
• Ko SM

• KMID: 1970176
• DOI: http://doi.org/10.4046/trd.2008.64.4.266

Abstract

BACKGROUND: Estimation of the probability of a patient having an acute pulmonary embolism (PE) for patients with a suspected PE are well established in North America and Europe. However, an assessment of the prediction rules for a PE has not been clearly defined in Korea. The aim of this study is to assess the prediction rules for patients with a suspected PE in Korea.
METHODS
We performed a retrospective study of 210 inpatients or patients that visited the emergency ward with a suspected PE where computed tomography pulmonary angiography was performed at a single institution between January 2005 and March 2007. Simplified Wells rules and revised Geneva rules were used to estimate the clinical probability of a PE based on information from medical records.
RESULTS
Of the 210 patients with a suspected PE, 49 (19.5%) patients had an actual diagnosis of a PE. The proportion of patients classified by Wells rules and the Geneva rules had a low probability of 1% and 21%, an intermediate probability of 62.5% and 76.2%, and a high probability of 33.8% and 2.8%, respectively. The prevalence of PE patients with a low, intermediate and high probability categorized by the Wells rules and Geneva rules was 100% and 4.5% in the low range, 18.2% and 22.5% in the intermediate range, and 19.7% and 50% in the high range, respectively. Receiver operating characteristic curve analysis showed that the revised Geneva rules had a higher accuracy than the Wells rules in terms of detecting PE. Concordance between the two prediction rules was poor (kappa coefficient=0.06).
CONCLUSION
In the present study, the two prediction rules had a different predictive accuracy for pulmonary embolisms. Applying the revised Geneva rules to inpatients and emergency ward patients suspected of having PE may allow a more effective diagnostic process than the use of the Wells rules.

Keyword

Pulmonary embolism; Diagnosis; Computed tomography

MeSH Terms

Angiography
Emergencies
Europe
Humans
Inpatients
Korea
North America
Prevalence
Pulmonary Embolism
Retrospective Studies
ROC Curve

Figure

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  Figure 1 Comparison of the predictive accuracy of the two methods for pulmonary embolism. (A) Specificity and sensitivity of Wells score, (B) Sensitivity and specificity of revised Geneva score.

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  Figure 2 ROC curve (Receiver Operating Characteristic curve) of Wells scoreand revised Geneva score. Area under the ROC curve=0.56 (95% CI: 0.46 to 0.66) for Wells score, area under the ROC curve=0.64 (95% CI: 0.55 to 0.73) for revised Geneva score.

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