Effectiveness of Clinical Decision Tools in Predicting Pulmonary Embolism

Objective. The Wells criteria and revised Geneva score are two commonly used clinical decision tools (CDTs) developed to assist physicians in determining when computed tomographic angiograms (CTAs) should be performed to evaluate the high index of suspicion for pulmonary embolism (PE). Studies have...

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Main Authors: Michael A. Simon, Christopher Tan, Patrick Hilden, Lyle Gesner, Barry Julius
Format: Article
Language:English
Published: Wiley 2021-01-01
Series:Pulmonary Medicine
Online Access:http://dx.doi.org/10.1155/2021/8880893
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author Michael A. Simon
Christopher Tan
Patrick Hilden
Lyle Gesner
Barry Julius
author_facet Michael A. Simon
Christopher Tan
Patrick Hilden
Lyle Gesner
Barry Julius
author_sort Michael A. Simon
collection DOAJ
description Objective. The Wells criteria and revised Geneva score are two commonly used clinical decision tools (CDTs) developed to assist physicians in determining when computed tomographic angiograms (CTAs) should be performed to evaluate the high index of suspicion for pulmonary embolism (PE). Studies have shown varied accuracy in these CDTs in identifying PE, and we sought to determine their accuracy within our patient population. Methods. Patients admitted to the Emergency Department (ED) who received a CTA for suspected PE from 2019 Jun 1 to 2019 Aug 31 were identified. Two CDTSs, the Wells criteria and revised Geneva score, were calculated based on data available prior to CTA and using the common D-Dimer cutoff of >500 μg/L. We determined the association between confirmed PE and CDT values and determined the association between the D-Dimer result and PE. Results. 392 CTAs were identified with 48 (12.1%) positive PE cases. The Wells criteria and revised Geneva score were significantly associated with PE but failed to identify 12.5% and 70.4% of positive PE cases, respectively. Within our cohort, a D-Dimer cutoff of >300 μg/L was significantly associated with PE and captured 95.2% of PE cases. Conclusions. Both CDTs were significantly associated with PE but failed to identify PE in a significant number of cases, particularly the revised Geneva score. Alternative D-Dimer cutoffs may provide better accuracy in identifying PE cases.
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spelling doaj-art-1de377b97c22449bac481e8cbafdcaee2025-02-03T01:06:16ZengWileyPulmonary Medicine2090-18362090-18442021-01-01202110.1155/2021/88808938880893Effectiveness of Clinical Decision Tools in Predicting Pulmonary EmbolismMichael A. Simon0Christopher Tan1Patrick Hilden2Lyle Gesner3Barry Julius4Department of Radiology, RWJBH–Saint Barnabas Medical Center, Livingston, New Jersey, USADepartment of Radiology, RWJBH–Saint Barnabas Medical Center, Livingston, New Jersey, USADepartment of Biostatistics, RWJBH–Saint Barnabas Medical Center, Livingston, New Jersey, USADepartment of Radiology, RWJBH–Saint Barnabas Medical Center, Livingston, New Jersey, USADepartment of Radiology, RWJBH–Saint Barnabas Medical Center, Livingston, New Jersey, USAObjective. The Wells criteria and revised Geneva score are two commonly used clinical decision tools (CDTs) developed to assist physicians in determining when computed tomographic angiograms (CTAs) should be performed to evaluate the high index of suspicion for pulmonary embolism (PE). Studies have shown varied accuracy in these CDTs in identifying PE, and we sought to determine their accuracy within our patient population. Methods. Patients admitted to the Emergency Department (ED) who received a CTA for suspected PE from 2019 Jun 1 to 2019 Aug 31 were identified. Two CDTSs, the Wells criteria and revised Geneva score, were calculated based on data available prior to CTA and using the common D-Dimer cutoff of >500 μg/L. We determined the association between confirmed PE and CDT values and determined the association between the D-Dimer result and PE. Results. 392 CTAs were identified with 48 (12.1%) positive PE cases. The Wells criteria and revised Geneva score were significantly associated with PE but failed to identify 12.5% and 70.4% of positive PE cases, respectively. Within our cohort, a D-Dimer cutoff of >300 μg/L was significantly associated with PE and captured 95.2% of PE cases. Conclusions. Both CDTs were significantly associated with PE but failed to identify PE in a significant number of cases, particularly the revised Geneva score. Alternative D-Dimer cutoffs may provide better accuracy in identifying PE cases.http://dx.doi.org/10.1155/2021/8880893
spellingShingle Michael A. Simon
Christopher Tan
Patrick Hilden
Lyle Gesner
Barry Julius
Effectiveness of Clinical Decision Tools in Predicting Pulmonary Embolism
Pulmonary Medicine
title Effectiveness of Clinical Decision Tools in Predicting Pulmonary Embolism
title_full Effectiveness of Clinical Decision Tools in Predicting Pulmonary Embolism
title_fullStr Effectiveness of Clinical Decision Tools in Predicting Pulmonary Embolism
title_full_unstemmed Effectiveness of Clinical Decision Tools in Predicting Pulmonary Embolism
title_short Effectiveness of Clinical Decision Tools in Predicting Pulmonary Embolism
title_sort effectiveness of clinical decision tools in predicting pulmonary embolism
url http://dx.doi.org/10.1155/2021/8880893
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