Values of the Wells and Revised Geneva Scores Combined with D-dimer in Diagnosing Elderly Pulmonary Embolism Patients

作     者：Dan-Jie Guo Can Zhao Ya-Dan Zou Xu-Hang Huang Jing-Min Hu Lin Guo Guo Dan-Jie;Zhao Can;Zou Ya-Dan;Huang Xu-Hang;Hu Jing-Min;Guo Lin

作者机构：Department of Cardiology Peking University People's Hospital Beijing 100044 China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2015年第128卷第8期

页      面：1052-1057页

核心收录：

学科分类：0710[理学-生物学] 090601[农学-基础兽医学] 071010[理学-生物化学与分子生物学] 1002[医学-临床医学] 07[理学] 09[农学] 0906[农学-兽医学] 

主　　题：D-dimer Elderly Pulmonary Embolism Revised Geneva Score Wells Score 

摘      要：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-dimcr, 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 sate strategy to rule out PE.