Source: Annual Congress 2006 - Pulmonary hypertension: thromo-embolic processes

Abstract

Introduction: Clinical prediction scores (CPS) for pulmonary emboli (PE) have been used with varying success to improve the pre-test probability and performance of diagnostic tests. We tested 2 different CPS together with raised d-dimers (quantatative immunoassay, Haemos-IL, UK). PEs were defined as present if seen on CT-PAs.
Methods:
a) retrospective study comparing the Wells and Geneva Scores and d-dimers at presentation, in a random sample of 21 patients with PEs (mean age 69 yrs) with 21 age-matched controls, with similar symptoms but no PEs.
b) prospective study of 155 consecutive patients referred for CT-PAs, to test the usefulness of the Wells score with d-dimers in predicting PEs.
Results:
a)

Table1

	PEs	No PEs	p-value
Mean Wells Score	4.3	1.8	0.001
Mean Geneva Score	6	4	0.02
Median d-dimers†	2387	657	0.001

† normal range<250

b) 9% of patients with a low risk Wells score had PEs, but 0% had PEs if they had a low Wells score and normal d-dimers (negative predictive value 100%). However, as most patients had raised d-dimers for other reasons we had low specificity and low positive predictive value and could have saved only 2-4% of scans.

Table2

	Wells et al	Our results
Incidence of PE	18%	21%
Score≤ 4 and -ve DD	567 out of 1260 (45%)	3 out of 155 (2%)
PE rate in excluded group	1.7%	0%

Conclusion:
CPS and d-dimers were significantly higher in those with PEs but were not specific / sensitive enough to not need further CT-PAs. Like Wells et al, we found a low score together with normal d-dimers can safely rule out PEs. However, this combination was rare in our series so we only would have saved 2% (not 45%) of scans. Better performing CPS and d-dimer assays are needed in our clinical setting.

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Citations should be made in the following way:
K. Khan, T. Paul, A. Hattab, A. P. Richards, K. E. Lewis (Llanelli, Swansea, United Kingdom). Clinical predictors of pulmonary emboli in an everyday setting. Eur Respir J 2006; 28: Suppl. 50, 2368

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