The diagnostic values of Wells score and modified Geneva score for pretesting acute pulmonary embolism: a prospective study / 中华内科杂志

ABSTRACT

Objective To assess the diagnostic predictive value of Wells score and modified Geneva score for acute pulmonary embolism by prospective case series and to explore a more suitable scoring system for Chinese population.Methods All the patients suspected of pulmonary embolism (PE) and received CT pulmonary angiography (CTPA) were enrolled consecutively in Fuxing Hospital,Capital Medical University,China,from June 2009 to August 2011.Before CTPA test or on condition that test results were unknown,clinical scoring was assessed prospectively by the Wells score and the modified Geneva score.The probability of PE in each patient was assessed and the patients were divided into low,moderate and high probability groups according to the clinical scores.The result of CTPA was used as the diagnostic gold standard for PE.Diagnostic accuracy in each group was analyzed.The predictive accuracy of both scores was compared by AUCROC curve.Results A total of 139 patients met our enrollment criteria and 117 eligible patients entered our study at last.PE was diagnosed in 47 patients by CTPA with an overall prevalence of 40.2％.Prevalence of PE in the low,moderate and high pretest probability groups assessed by the Wells score and by the simplified modified Geneva score were 7.1％ (3/42),42.9％ (21/49),88.5％ (23/26)and 10.0％ (3/30),48.1％ (37/77),7/10,respectively.AUCROC curves for the Wells score and the simplified modified Geneva score were 0.872 ( 95％ CI 0.810-0.933 ) and 0.734 ( 95％ CI 0.643-0.825 )respectively,with a significant difference ( P =0.005 ).Conclusion The Wells score is more accurate for clinical predicting acute PE than the modified Geneva score.