Predictive value of Wells and Geneva score in suspected pulmonary thromboembolism in critically ill patients with COVID 19: A retrospective study

ABSTRACT

Background: Critically ill patients with COVID 19 are at high risk for pulmonary embolism (PE). Specific PE prediction rules have not been validated in this population yet. Aim(s) The present sub study of national project (20.80009.8007.28) aimed to assessed the Wells and revised Geneva scoring systems as predictors of PE in critically ill patients with coronavirus SARSCOV2. Method(s) Study included patients with PE. A sub analyses was performed on patients with COVID positive test. Pulmonary CT angiograms (CTAs) performed for suspected PE in critically ill adult patients were retrospectively identified. Wells and revised Geneva scores were calculated based on information from medical records. Patients were dichotomized into low and intermediate/high probability groups. The reliability of both scores as predictors of PE was determined using receiver operating characteristic (ROC) curve analysis. Result(s) Of 108 patients, 42 (38.8%) were positive for PE based on pulmonary CTA. The mean group value of the Wells score was 3.8 points, with 46.2% of patients having a score of >=3, which qualifies the patient with probable PE. The average value of the Geneva score represents 7.78 points, and 60.99% of patients qualify in the group with probable PE. According to the Wells and revised Geneva scores, (52.2%) patients and (39.1%) patients, respectively, were considered as low probability for PE. Of those considered as low risk by the Wells score, 25.8% had filling defects on CTA, including 2 patients with main pulmonary artery embolism. The area under the ROC curve was 0.64 for the Wells score and 0.56 for the revised Geneva score. Wells score >4 had a sensitivity of 38%, specificity of 77%, positive predictive value of 49%, and negative predictive value of 73% to predict risk of PE. Conclusion(s) In this population of critically ill patients with covid 19, Wells and revised Geneva scores were not reliable predictors of PE.