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Comparison of Wells and Revised Geneva Rule to Assess Pretest Probability of Pulmonary Embolism in High‐Risk Hospitalized Elderly Adults
Author(s) -
Di Marca Salvatore,
Cilia Chiara,
Campagna Andrea,
D'Arrigo Graziella,
ElHafeez Samar Abd,
Tripepi Giovanni,
Puccia Giuseppe,
Pisano Marcella,
Mastrosimone Gianluca,
Terranova Valentina,
Cardella Antonella,
Buonacera Agata,
Stancanelli Benedetta,
Zoccali Carmine,
Malatino Lorenzo
Publication year - 2015
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13459
Subject(s) - medicine , receiver operating characteristic , confidence interval , pre and post test probability , pulmonary embolism , chest pain , area under the curve , physical therapy
Objectives To assess and compare the diagnostic power for pulmonary embolism ( PE ) of Wells and revised G eneva scores in two independent cohorts (training and validation groups) of elderly adults hospitalized in a non‐emergency department. Design Prospective clinical study, J anuary 2011 to J anuary 2013. Setting Unit of I nternal M edicine inpatients, U niversity of C atania, I taly. Participants Elderly adults (mean age 76 ± 12), presenting with dyspnea or chest pain and with high clinical probability of PE or D ‐dimer values greater than 500 ng/mL (N = 203), were enrolled and consecutively assigned to a training (n = 101) or a validation (n = 102) group. The clinical probability of PE was assessed using W ells and revised G eneva scores. Measurements Clinical examination, D ‐dimer test, and multidetector computed angiotomography were performed in all participants. The accuracy of the scores was assessed using receiver operating characteristic analyses. Results PE was confirmed in 46 participants (23%) (24 training group, 22 validation group). In the training group, the area under the receiver operating characteristic curve was 0.91 (95% confidence interval ( CI ) = 0.85–0.98) for the W ells score and 0.69 (95% CI = 0.56–0.82) for the revised G eneva score ( P < .001). These results were confirmed in the validation group ( P < .05). The positive ( LR +) and negative likelihood ratios ( LR −) (two indices combining sensitivity and specificity) of the Wells score were superior to those of the revised G eneva score in the training ( LR +, 7.90 vs 1.34; LR −, 0.23 vs 0.66) and validation ( LR +, 13.5 vs 1.46; LR −, 0.47 vs 0.54) groups. Conclusion In high‐risk elderly hospitalized adults, the W ells score is more accurate than the revised G eneva score for diagnosing PE .