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Values of the Wells and revised Geneva scores combined with D-dimer in diagnosing elderly pulmonary embolism patients.
Chin Med J (Engl). 2015 Apr 20; 128(8):1052-7.CM

Abstract

BACKGROUND

Pulmonary embolism (PE) can be difficult to diagnose in elderly patients because of the coexistent diseases and the combination of drugs that they have taken. We aimed to compare the clinical diagnostic values of the Wells score, the revised Geneva score and each of them combined with D-dimer for suspected PE in elderly patients.

METHODS

Three hundred and thirty-six patients who were admitted for suspected PE were enrolled retrospectively and divided into two groups based on age (≥65 or <65 years old). The Wells and revised Geneva scores were applied to evaluate the clinical probability of PE, and the positive predictive values of both scores were calculated using computed tomography pulmonary arteriography as a gold standard; overall accuracy was evaluated by the area under the curve (AUC) of receiver operator characteristic curve; the negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were calculated.

RESULTS

Ninety-six cases (28.6%) were definitely diagnosed as PE among 336 cases, among them 56 cases (58.3%) were ≥65 years old. The positive predictive values of Wells and revised Geneva scores were 65.8% and 32.4%, respectively (P < 0.05) in the elderly patients; the AUC for the Wells score and the revised Geneva score in elderly was 0.682 (95% confidence interval [CI]: 0.612-0.746) and 0.655 (95% CI: 0.584-0.722), respectively (P = 0.389). The negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were 93.7%, 100%, and 100% in the elderly, respectively.

CONCLUSIONS

The diagnostic value of the Wells score was higher than the revised Geneva score for the elderly cases with suspected PE. The combination of either the Wells score or the revised Geneva score with a normal D-dimer concentration is a safe strategy to rule out PE.

Authors+Show Affiliations

Department of Cardiology, Peking University People's Hospital, Beijing 100044, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25881599

Citation

Guo, Dan-Jie, et al. "Values of the Wells and Revised Geneva Scores Combined With D-dimer in Diagnosing Elderly Pulmonary Embolism Patients." Chinese Medical Journal, vol. 128, no. 8, 2015, pp. 1052-7.
Guo DJ, Zhao C, Zou YD, et al. Values of the Wells and revised Geneva scores combined with D-dimer in diagnosing elderly pulmonary embolism patients. Chin Med J (Engl). 2015;128(8):1052-7.
Guo, D. J., Zhao, C., Zou, Y. D., Huang, X. H., Hu, J. M., & Guo, L. (2015). Values of the Wells and revised Geneva scores combined with D-dimer in diagnosing elderly pulmonary embolism patients. Chinese Medical Journal, 128(8), 1052-7. https://doi.org/10.4103/0366-6999.155085
Guo DJ, et al. Values of the Wells and Revised Geneva Scores Combined With D-dimer in Diagnosing Elderly Pulmonary Embolism Patients. Chin Med J (Engl). 2015 Apr 20;128(8):1052-7. PubMed PMID: 25881599.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Values of the Wells and revised Geneva scores combined with D-dimer in diagnosing elderly pulmonary embolism patients. AU - Guo,Dan-Jie, AU - Zhao,Can, AU - Zou,Ya-Dan, AU - Huang,Xu-Hang, AU - Hu,Jing-Min, AU - Guo,Lin, PY - 2015/4/18/entrez PY - 2015/4/18/pubmed PY - 2015/9/29/medline SP - 1052 EP - 7 JF - Chinese medical journal JO - Chin Med J (Engl) VL - 128 IS - 8 N2 - BACKGROUND: Pulmonary embolism (PE) can be difficult to diagnose in elderly patients because of the coexistent diseases and the combination of drugs that they have taken. We aimed to compare the clinical diagnostic values of the Wells score, the revised Geneva score and each of them combined with D-dimer for suspected PE in elderly patients. METHODS: Three hundred and thirty-six patients who were admitted for suspected PE were enrolled retrospectively and divided into two groups based on age (≥65 or <65 years old). The Wells and revised Geneva scores were applied to evaluate the clinical probability of PE, and the positive predictive values of both scores were calculated using computed tomography pulmonary arteriography as a gold standard; overall accuracy was evaluated by the area under the curve (AUC) of receiver operator characteristic curve; the negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were calculated. RESULTS: Ninety-six cases (28.6%) were definitely diagnosed as PE among 336 cases, among them 56 cases (58.3%) were ≥65 years old. The positive predictive values of Wells and revised Geneva scores were 65.8% and 32.4%, respectively (P < 0.05) in the elderly patients; the AUC for the Wells score and the revised Geneva score in elderly was 0.682 (95% confidence interval [CI]: 0.612-0.746) and 0.655 (95% CI: 0.584-0.722), respectively (P = 0.389). The negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were 93.7%, 100%, and 100% in the elderly, respectively. CONCLUSIONS: The diagnostic value of the Wells score was higher than the revised Geneva score for the elderly cases with suspected PE. The combination of either the Wells score or the revised Geneva score with a normal D-dimer concentration is a safe strategy to rule out PE. SN - 2542-5641 UR - https://www.unboundmedicine.com/medline/citation/25881599/Values_of_the_Wells_and_revised_Geneva_scores_combined_with_D_dimer_in_diagnosing_elderly_pulmonary_embolism_patients_ L2 - https://doi.org/10.4103/0366-6999.155085 DB - PRIME DP - Unbound Medicine ER -