Comparison of Wells and Revised Geneva Rule to Assess Pretest Probability of Pulmonary Embolism in High‐Risk Hospitalized Elderly Adults

Abstract

In high-risk elderly hospitalized adults, the Wells score is more accurate than the revised Geneva score for diagnosing PE.

Underuse of risk assessment and overuse of computed tomography pulmonary angiography in patients with suspected pulmonary thromboembolism

“…Predictive values indicated that all rules were most useful in reducing the risk of PTE to less than 15% in patients categorised as having low‐risk scores. These findings are similar to those reported from other centres with a negative predictive value of 85–90% . However, in the absence of negative D‐dimer assays in all such cases, this risk of PTE is likely to remain unacceptably high for many clinicians who will subsequently request a CTPA.…”

“…These findings are similar to those reported from other centres with a negative predictive value of 85-90%. 30,31 However, in the absence of negative D-dimer assays in all such cases, this risk of PTE is likely to remain unacceptably high for many clinicians who will subsequently request a CTPA.…”

Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Suspected Acute Venous Thromboembolic Disease

“…The diagnosis of PE poses a special challenge in the elderly, given that its prevalence increases with age, 4 as does the frequency of comorbid conditions that can present with similar signs and symptoms. Although the accuracy and clinical utility of prediction rules remain good in this population, 40,41 there is an age-dependent increase in D-dimer levels 42 that results in a decline in the specificity of D-dimer testing in the elderly when a conventional fixed cutoff is used. This can lead to high rates of unnecessary imaging in this group.…”

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

“…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).…”