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Assessing Pretest Clinical Risk of Pulmonary Thromboembolism in the Emergency Department: Proposal of a Simple Modification to the Wells' Score.
Spampinato, Michele Domenico; Bucci, Simone; Migliano, Maria Teresa; Ricciardelli, Maria Adelina; Strada, Andrea; Rossin, Federica; Rotini, Carlotta; Manfredini, Roberto; De Giorgio, Roberto; Ursini, Francesco.
Afiliación
  • Spampinato MD; Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
  • Bucci S; Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
  • Migliano MT; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
  • Ricciardelli MA; Emergency Medicine, Azienda Unità Sanitaria Locale, Ferrara, Italy.
  • Strada A; Emergency Medicine, St. Anna Hospital, Ferrara, Italy.
  • Rossin F; Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
  • Rotini C; Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
  • Manfredini R; Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
  • De Giorgio R; Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
  • Ursini F; Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
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.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Embolia Pulmonar Tipo de estudio: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / 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

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Embolia Pulmonar Tipo de estudio: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / 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