[Prognostic scores for pulmonary embolism]. / Scores pronostiques pour l'embolie pulmonaire.

Nine prognostic scores for pulmonary embolism (PE), based on retrospective and prospective studies, published between 2000 and 2014, have been analyzed and compared. Most of them aim at identifying PE cases with a low risk to validate their ambulatory care. Important differences in the considered outcomes: global mortality, PE-specific mortality, other complications, sizes of low risk groups, exist between these scores. The most popular score appears to be the PESI and its simplified version. Few good quality studies have tested the applicability of these scores to PE outpatient care, although this approach tends to already generalize in the medical practice.

[Clinical scores for the risk of recurrent VTED and for the relationship cancer-VTED]. / Scores cliniques pour le risque de récidive de maladie veineuse thromboembolique (MVTE) et pour les relations cancer-MVTE.

Clinical scores related to the risk of recurrent venous thromboembolic disease (VTED), to the relationship between cancer and VTED (risk of development of VTED, risk of recurrent VTED, prognosis of pulmonary embolism) and to the risk of cancer following VTED are analysed and commented upon. Although they most often rely on appropriate methodology and are often based on a large number of subjects, they unfortunately provide information that is not necessarily useful for the care of patients. Their use should be considered only when positive impact studies are published.

[Clinical scores for the risk of bleeding with or without anticoagulation]. / Les scores cliniques dans la maladie veineuse thromboembolique (MVTE). Une aide dans la décision diagnostique et thérapeutique ?: Scores cliniques pour le risque de saignement avec ou sans anticoagulation.

The assessment of hemorragic risk related to therapeutic anticoagulation is made difficult because of the variety of existing drugs, the heterogeneity of treatment strategies and their duration. Six prognostic scores have been analyzed. For three of them, external validations have revealed a marked decrease in the discrimination power. One British study, Qbleed, based on the data of more than 1 million of ambulatory patients, has repeatedly satisfied quality criteria. Two scores have also studied the bleeding risk during hospital admission for acute medical disease. The development of new and effective anticoagulants with fewer side-effects is more likely to solve this problem than the production of new clinical scores.

L'évaluation du risque hémorragique sur anticoagulation thérapeutique en cas de maladie veineuse tromboembolique est difficile en raison de la variété des médicaments disponibles, de l'hétérogénéité des indications au traitement et à sa durée. Six scores pronostiques sont analysés ; trois d'entre eux ont présenté, lors de validations externes, une forte baisse de la capacité de discrimination. Une étude britannique, Qbleed, basée sur les données informatiques de plus d'un million de sujets, répond de façon répétée aux critères de qualité requis. Deux scores analysent aussi le risque de saignement survenant lors d'hospitalisation pour affection médicale aiguë. Il y a probablement plus à attendre du développement de nouveaux anticoagulants générant moins d'effets secondaires indésirables que de la formulation de nouveaux scores prédictifs de saignements.

[Chronic obstructive pulmonary disease: 2. Short-term prognostic scores for acute exacerbations]. / Bronchopneumopathie chronique obstructive: 2. Scores pronostiques a court terme en cas d'exacerbation aiguë.

The chronic obstructive pulmonary disease or COPD is a slowly progressive disease whose course is frequently the subject of acute episodes, of variable severity, although, in general, reversible, called acute exacerbations. In the past five years (between 2008 and 2013), seven prognostic scores have been published to try to assess the short-term risk of these acute exacerbations. Their components and characteristics are analysed and commented upon. An Internet program with a detailed compilation of the main features of these scores (www.medhyg.ch/scoredoc) supplements this review.

[Chronic obstructive pulmonary disease: I. Long-term prognostic scores]. / Bronchopneumopathie chronique obstructive: 1. Scores pronostiques a long terme.

The chronic obstructive pulmonary disease or COPD will probably be in the year 2020 the third cause of death in the world. It appears therefore appropriate to try to make available tools capable of assessing the prognosis of patients with this disease. In the first part of this series of two papers, the question of the prognosis of stable COPD over several years is addressed. Eight prognostic scores are discussed, all of them published between 2004 and 2012. Their components and characteristics are analysed and commented upon, with, in particular, emphasis on their discriminating power. An Internet program (www.medhyg. ch/scoredoc) supplements this review.

Brief report: beyond clinical experience: features of data collection and interpretation that contribute to diagnostic accuracy.

BACKGROUND: Clinical experience, features of data collection process, or both, affect diagnostic accuracy, but their respective role is unclear. OBJECTIVE, DESIGN: Prospective, observational study, to determine the respective contribution of clinical experience and data collection features to diagnostic accuracy. METHODS: Six Internists, 6 second year internal medicine residents, and 6 senior medical students worked up the same 7 cases with a standardized patient. Each encounter was audiotaped and immediately assessed by the subjects who indicated the reasons underlying their data collection. We analyzed the encounters according to diagnostic accuracy, information collected, organ systems explored, diagnoses evaluated, and final decisions made, and we determined predictors of diagnostic accuracy by logistic regression models. RESULTS: Several features significantly predicted diagnostic accuracy after correction for clinical experience: early exploration of correct diagnosis (odds ratio [OR] 24.35) or of relevant diagnostic hypotheses (OR 2.22) to frame clinical data collection, larger number of diagnostic hypotheses evaluated (OR 1.08), and collection of relevant clinical data (OR 1.19). CONCLUSION: Some features of data collection and interpretation are related to diagnostic accuracy beyond clinical experience and should be explicitly included in clinical training and modeled by clinical teachers. Thoroughness in data collection should not be considered a privileged way to diagnostic success.