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

Abstract

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.

Correlation between the Wells score and the Quanadli index in patients with pulmonary embolism

“…One retrospective observational research included 286 hospitalized patients with suspected PE (patients had previously received prophylactic doses of heparin), and PE was confirmed in 57 patients (20%). There was 95% sensitivity in this group, and 27% specificity, 27%, PPV 9% and NPV 99% for modified Wells criteria, which is in line with our results.…”

Prediction Scores Do Not Correlate with Clinically Adjudicated Categories of Pulmonary Embolism in Critically Ill Patients

“…Unlike some patients studied in the original prediction score studies, ICU patients in the present study were all receiving either UFH or LMWH thromboprophylaxis and had poor cardiopulmonary reserve, which may have influenced the threshold of concerns when various signs or symptoms were found. The original prediction score studies were also not necessarily completed in thromboprophylaxed patients; however, they have been found to be discriminatory in this population (13).…”

Justification of routine venous thromboembolism prophylaxis in head and neck cancer reconstructive surgery

“…The incidence of DVT was confirmed with lower extremity venous duplex ultrasound and PE was confirmed by gold standard chest CT pulmonary angiogram. Risk factors were primarily evaluated in referring to the Davison‐Caprini Risk‐Assessment Model and the Wells criteria …”

“…Risk factors were primarily evaluated in referring to the Davison-Caprini Risk-Assessment Model 16,17 and the Wells criteria. 18,19…”