Predictive value of revised Geneva score,ECG score and D-dimer in pulmonary embolism / 安徽医科大学学报

Objective To evaluate the value of revised Geneva score, Daniel ECG score and age-adjusted D-dimer for predicting pulmonary embolism(PE).Methods A total of 91 cases suspected as pulmonary embolism were collected, and 52 cases were diagnosed as pulmonary embolism by computed tomographic pulmonary angiography(CTPA) results.Receiver operating characteristic(ROC) curves and diagnostic test evaluation indexes were used to evaluate the probability of PE predicted by the revised Geneva score,Daniel ECG score, age-adjusted D-dimer and combination of these two clinical scores and age-adjusted D-dimer.Results The confirmed PE was 21.4% with a low probability(revised Geneva score 0~3 points),55.4% in intermediate probability(4~10 points),85.7% in high probability(score≥11 points).The prevalence of PE was 33.3% with a low clinical probability (Daniel ECG score<2 points)and 70.7% with a high clinical probability(Daniel ECG score≥2 points).The sensitivity and specificity of age-adjusted D-dimer in predicting pulmonary embolism were 92.3%,69.2%.The area under curve of the ROC curve(AUC)in the revised Geneva score and Daniel ECG score has no significant difference(Z=0.979).The negative predictive value of the revised Geneva score, Daniel ECG score combined with D-dimer in pulmonary embolism were 100.0% and 87.5%.Conclusion All of revised Geneva score, Daniel ECG score and age-adjusted D-dimer have certain predictive value on pulmonary embolism , and the revised Geneva score combined with age-adjusted D-dimer can be more safely exclude pulmonary embolism.

Predication of three kinds of scoring model for type 2 diabetes mellitus withacute pulmonary thromboembo-lism / 医学研究生学报

Objective There were few studies of prediction on type 2 diabetic patients with acute pulmonary thromboembo?lism.To evaluate the performance of the Padua score, revised Geneva score and Wells PE score in the prediction value of diagnosis of type 2 diabetes mellitus with acute pulmonary thromboembolism( APTE) . Methods 151cases with suspected APTE of type 2 diabe?tes were collected from January 2013 to December 2015 by a retrospective case analysis mode. Among 151 pations,80 cases had diag?nosed with pulmonary thromboembolism.The receiver operating characteristic (ROC) curve was used to evaluate the probability of type 2 diabetic patients with APTE predicted by the Padua, the revised Geneva and the Wells PE score. We calculated the Youden Index for the cut?off point. Results The area under curve( AUC) of the ROC curve in the Padua score, revised Geneva score and Wells PE score for APTE was 0.804±0.035、0.635±0.045 and 0.705±0.043. The area under the ROC curve of the Padua score was the highest and there was a significant difference compared with the revised Geneva( P0.016 7) . The comparison of revised Geneva score and Wells PE for the predication value was no statistically significant difference ( P>0.016 7) . The cut?off of Padua score was 3 points and Youden Index was 0.51. The cut?off of Revised Geneva was 3 points and Youden In?dex was 0.24. The cut?off of Wells PE score was 1 points and Youden Index was 0.39. Conclusion Padua score, revised Geneva score and Wells PE score in predicting diabetes patients have some ex?tent clinical value terms, which Padua score has higher predictive value than the Revised Geneva.The predictive value of Padua score and Wells PE score was equivalent.However, the predictive value of Padua score is limited.

Comparison of the screening effects between Wells and revised Geneva scores on suspected acute pulmonary thromboembolism / 中华急诊医学杂志

Objective To compare the screening effects between Wells and revised Geneva scores on suspected acute pulmonary thromboembolism (APTE),and to explore a optimum screening method for APTE in the emergency department of China.Methods The study was carried out by using random,crossed,prospective methods to compare the screening effects between Wells and revised Geneva scores for 167 suspected APTE patients in the emergency department of the First Affiliated Hospital of Xiamen University.Results The areas under the receiver operating characteristic curve of Wells and revised Geneva scores for screening APTE in the emergency department were (0.917 ± 0.022 ) and (0.927 ± 0.020),respectively ( P ＜ 0.05 ).The diagnostic concordance between the two score systems for predicting APTE was poor (Kappa value =0.276 ). In addition, the difference between their hierarchical discrimination for the possibility of APTE was statistically significant ( P ＜ 0.05 ).Compared with revised Geneva score,fewer patients were diagnosed with low clinical probability of APTE and more patients were diagnosed with intermediate or high clinical probability of APTE through Wells score.The patients with low chnical probability of APTE were excluded from pulmonary embolism in Wells or revised Geneva score.At intermediate clinical probability,the accuracy rate of Wells score for predicting APTE (9.64％) was lower than that (32.84％ ) of revised Geneva ( P ＜ 0.05 ).At high clinical probability,there was no significant difference between their accuracy rate [ (67.24％ vs.86.21％),P＞0.05]. Conclusions Revised Geneva score is more suitable than Wells score in screening suspected APTE patients in the emergency department in our country.

Predication of Wells and Revised Geneva Scores for Pulmonary Embolism / 中山大学学报(医学科学版)

[Objective] To reduce misdiagnosis and underdiagnosis rate of pulmonary embolism,the prediction of the revised Geneva score and Wells score for pulmonary embolism were compared and analyzed by receiver operating characteristic curves.[Methods] Sixty-five cases with suspected pulmonary embolism (PE) were collected in the Third Affiliated Hospital of SUN Yat-sen University from January 1998 to October 2008.Of which 44 cases with PE were clinically confirmed.Relevant clinical data were recorded,summarized and the analysis variables were input to SPSS11.0 for statistical analysis.ROC curves was used to evaluate the probability of PE predicted by the Wells and the revised Geneva scores.[Results] Twenty-four patients had a low clinical probability of PE (Wells score ＜ 2 points ),of which 8 (33.3%) had proven PE.The prevalence of PE was 87.2% in the 39 patients with intermediate probability (2-6 points) and 100% in the 2 patients with high probability (＞ 6 points) (P ＝ 0.000).The confirmed PE was 22.2% in the 18 patients with a low probability (Geneva score 0-3 points),82.1% (32/39) in intermediate probability (4-10 points),100% (8/8) in high probability (score ≥11 points) (P ＝ 0.000).The area under curve (AUC) of the ROC curve in the Wells and Geneva scores was 0.785 ± 0.060 and 0.900 ± 0.038,respectively (P ＝ 0.000).The optimal cutoff value was 2 points in the Wells score and 6.5 points in the Geneva score.The Wells score more than 2 points predicted PE with a sensitivity of 81.8% and specificity of 76.2%.The Geneva score more than 6 points predicted PE with a sensitivity of 72.7% and specificity of 100%.The comparison of the area under curve between the Wells and the Geneva score had a significant difference statistically (P ＜ 0.05).[Conclusion] The Wells score and the revised Geneva score are beneficial to predict pulmonary embolism.The revised Geneva score is roughly superior to the Wells score both in sensitivity and specificity.