Assessing clinical probability of pulmonary embolism: prospective validation of the simplified Geneva score.
- Robert-Ebadi H Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland.
- Mostaguir K Clinical Research Center, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
- Hovens MM Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands.
- Kare M Emergency room, Centre Hospitalier d'Agen, Agen, France.
- Verschuren F Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.
- Girard P Département Thoracique, L'Institut Mutualiste Montsouris, Paris, France.
- Huisman MV Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
- Moustafa F Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.
- Kamphuisen PW Department of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
- Buller HR Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.
- Righini M Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland.
- Le Gal G Ottawa Hospital Research Institute, Ottawa, Canada.
- 2017-07-09
Published in:
- Journal of thrombosis and haemostasis : JTH. - 2017
age-adjusted D-dimer cut-off
clinical prediction rules
diagnosis
diagnostic tests
pulmonary embolism
Aged
Biomarkers
Clinical Decision-Making
Decision Support Techniques
Europe
Female
Fibrin Fibrinogen Degradation Products
Humans
Male
Middle Aged
Predictive Value of Tests
Prevalence
Prognosis
Prospective Studies
Pulmonary Embolism
Reproducibility of Results
Retrospective Studies
Risk Factors
English
Essentials The simplified Geneva score allows easier pretest probability assessment of pulmonary embolism (PE). We prospectively validated this score in the ADJUST-PE management outcome study. The study shows that it is safe to manage patients with suspected PE according to this score. The simplified Geneva score is now ready for use in routine clinical practice.
SUMMARY
Background Pretest probability assessment by a clinical prediction rule (CPR) is an important step in the management of patients with suspected pulmonary embolism (PE). A limitation to the use of CPRs is that their constitutive variables and corresponding number of points are difficult to memorize. A simplified version of the Geneva score (i.e. attributing one point to each variable) has been proposed but never been prospectively validated. Aims Prospective validation of the simplified Geneva score (SGS) and comparison with the previous version of the Geneva score (GS). Methods In the ADJUST-PE study, which had the primary aim of validating the age-adjusted D-dimer cut-off, the SGS was prospectively used to determine the pretest probability in a subsample of 1621 study patients. Results Overall, PE was confirmed in 294 (18.1%) patients. Using the SGS, 608 (37.5%), 980 (60.5%) and 33 (2%) were classified as having a low, intermediate and high clinical probability. Corresponding prevalences of PE were 9.7%, 22.4% and 45.5%; 490 (30.1%) patients with low or intermediate probability had a D-dimer level below 500 μg L-1 and 653 (41.1%) had a negative D-dimer test according to the age-adjusted cut-off. Using the GS, the figures were 491(30.9%) and 650 (40.9%). None of the patients considered as not having PE based on a low or intermediate SGS and negative D-dimer had a recurrent thromboembolic event during the 3-month follow-up. Conclusions The use of SGS has similar efficiency and safety to the GS in excluding PE in association with the D-dimer test.
SUMMARY
Background Pretest probability assessment by a clinical prediction rule (CPR) is an important step in the management of patients with suspected pulmonary embolism (PE). A limitation to the use of CPRs is that their constitutive variables and corresponding number of points are difficult to memorize. A simplified version of the Geneva score (i.e. attributing one point to each variable) has been proposed but never been prospectively validated. Aims Prospective validation of the simplified Geneva score (SGS) and comparison with the previous version of the Geneva score (GS). Methods In the ADJUST-PE study, which had the primary aim of validating the age-adjusted D-dimer cut-off, the SGS was prospectively used to determine the pretest probability in a subsample of 1621 study patients. Results Overall, PE was confirmed in 294 (18.1%) patients. Using the SGS, 608 (37.5%), 980 (60.5%) and 33 (2%) were classified as having a low, intermediate and high clinical probability. Corresponding prevalences of PE were 9.7%, 22.4% and 45.5%; 490 (30.1%) patients with low or intermediate probability had a D-dimer level below 500 μg L-1 and 653 (41.1%) had a negative D-dimer test according to the age-adjusted cut-off. Using the GS, the figures were 491(30.9%) and 650 (40.9%). None of the patients considered as not having PE based on a low or intermediate SGS and negative D-dimer had a recurrent thromboembolic event during the 3-month follow-up. Conclusions The use of SGS has similar efficiency and safety to the GS in excluding PE in association with the D-dimer test.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1111/jth.13770
- PMID 28688113
- Persistent URL
- https://sonar.rero.ch/global/documents/110386
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