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Abstract
Background
Estimation of the probability of a patient having an acute pulmonary embolism (PE) for patients with a suspected PE are well established in North America and Europe. However, an assessment of the prediction rules for a PE has not been clearly defined in Korea. The aim of this study is to assess the prediction rules for patients with a suspected PE in Korea.
Methods
We performed a retrospective study of 210 inpatients or patients that visited the emergency ward with a suspected PE where computed tomography pulmonary angiography was performed at a single institution between January 2005 and March 2007. Simplified Wells rules and revised Geneva rules were used to estimate the clinical probability of a PE based on information from medical records.
Results
Of the 210 patients with a suspected PE, 49 (19.5%) patients had an actual diagnosis of a PE. The proportion of patients classified by Wells rules and the Geneva rules had a low probability of 1% and 21%, an intermediate probability of 62.5% and 76.2%, and a high probability of 33.8% and 2.8%, respectively. The prevalence of PE patients with a low, intermediate and high probability categorized by the Wells rules and Geneva rules was 100% and 4.5% in the low range, 18.2% and 22.5% in the intermediate range, and 19.7% and 50% in the high range, respectively. Receiver operating characteristic curve analysis showed that the revised Geneva rules had a higher accuracy than the Wells rules in terms of detecting PE. Concordance between the two prediction rules was poor (κ coefficient=0.06).
Figures and Tables
Figure 1
Comparison of the predictive accuracy of the two methods for pulmonary embolism. (A) Specificity and sensitivity of Wells score, (B) Sensitivity and specificity of revised Geneva score.
Figure 2
ROC curve (Receiver Operating Characteristic curve) of Wells scoreand revised Geneva score. Area under the ROC curve=0.56 (95% CI: 0.46 to 0.66) for Wells score, area under the ROC curve=0.64 (95% CI: 0.55 to 0.73) for revised Geneva score.
Table 3
Proportions of patients and frequency of pulmonary embolism in the two clinical probabilities
References
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