Assessing Pretest Clinical Risk of Pulmonary Thromboembolism in the Emergency Department: Proposal of a Simple Modification to the Wells' Score.
J Emerg Med
; 58(3): 385-390, 2020 Mar.
Article
en En
| MEDLINE
| ID: mdl-31964543
ABSTRACT
BACKGROUND:
Clinical scores have been proposed to stratify the risk of pulmonary thromboembolism (PTE), although this approach suffers a low specificity and the unavoidable need for computed tomography pulmonary angiography (CTPA) scans.OBJECTIVE:
Our study aimed to investigate a simple modification to the already validated Wells' score to improve its diagnostic accuracy in the emergency department (ED).METHODS:
We retrospectively reviewed all CTPA scans performed in the ED setting to rule out PTE over a 1-year (2017) period. Clinical variables potentially associated with PTE were assessed to improve diagnostic accuracy of the Wells' score, thus introducing a modified Wells' score (mWells).RESULTS:
Four thousand four hundred thirteen CTPAs were identified, of which 504 were for suspected PTE. The prevalence of PTE was 23.9%. Among clinical data, only peripheral capillary oxygen saturation was consistently correlated with PTE at univariate (odds ratio 2.75 [95% confidence interval 1.61-4.73]) and multivariate (odds ratio 3.78 [95% confidence interval 2.13-6.72]) logistic regression analysis. The mWells' score had a higher area under the receiver operating characteristic curve compared with the original Wells' score 0.71 (95% confidence interval 0.67-0.75) vs. 0.65 (95% confidence interval 0.61-0.69) (p < .01) and improved diagnostic accuracy.CONCLUSIONS:
Current clinical stratification tools for PTE are characterized by low specificity, leading to an overuse of CTPA. mWells', rather than Wells', score showed a better predictive performance of PTE detection. Our results suggest that current diagnostic pathway for PTE may be improved by simple adjustments (i.e., mWells') of clinical prediction scores.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Embolia Pulmonar
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Humans
Idioma:
En
Revista:
J Emerg Med
Asunto de la revista:
MEDICINA DE EMERGENCIA
Año:
2020
Tipo del documento:
Article
País de afiliación:
Italia