Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland.
J Thromb Haemost. 2010 May;8(5):957-70. doi: 10.1111/j.1538-7836.2010.03801.x. Epub 2010 Feb 2.
Pretest probability assessment is necessary to identify patients in whom pulmonary embolism (PE) can be safely ruled out by a negative D-dimer without further investigations.
Review and compare the performance of available clinical prediction rules (CPRs) for PE probability assessment.
PATIENTS/METHODS: We identified studies that evaluated a CPR in patients with suspected PE from Embase, Medline and the Cochrane database. We determined the 95% confidence intervals (CIs) of prevalence of PE in the various clinical probability categories of each CPR. Statistical heterogeneity was tested.
We identified 9 CPR and included 29 studies representing 31215 patients. Pooled prevalence of PE for three-level scores (low, intermediate or high clinical probability) was: low, 6% (95% CI, 4-8), intermediate, 23% (95% CI, 18-28) and high, 49% (95% CI, 43-56) for the Wells score; low, 13% (95% CI, 8-19), intermediate, 35% (95% CI, 31-38) and high, 71% (95% CI, 50-89) for the Geneva score; low, 9% (95% CI, 8-11), intermediate, 26% (95% CI, 24-28) and high, 76% (95% CI, 69-82) for the revised Geneva score. Pooled prevalence for two-level scores (PE likely or PE unlikely) was 8% (95% CI,6-11) and 34% (95% CI,29-40) for the Wells score, and 6% (95% CI, 3-9) and 23% (95% CI, 11-36) for the Charlotte rule.
Available CPR for assessing clinical probability of PE show similar accuracy. Existing scores are, however, not equivalent and the choice among various prediction rules and classification schemes (three- versus two-level) must be guided by local prevalence of PE, type of patients considered (outpatients or inpatients) and type of D-dimer assay applied.
为了通过阴性 D-二聚体排除疑似肺栓塞（PE）患者的肺栓塞，需要进行预测概率评估。
回顾和比较现有的用于 PE 可能性评估的临床预测规则（CPR）。
患者/方法：我们从 Embase、Medline 和 Cochrane 数据库中确定了评估疑似 PE 患者 CPR 的研究。我们确定了每个 CPR 各种临床概率类别的 PE 患病率的 95%置信区间（CI）。测试了统计异质性。
我们确定了 9 项 CPR，并纳入了代表 31215 名患者的 29 项研究。Wells 评分的三分类评分（低、中、高临床概率）的 PE 患病率为：低，6%（95%CI，4-8），中，23%（95%CI，18-28），高，49%（95%CI，43-56）；日内瓦评分的低、中、高临床概率的 PE 患病率分别为：低，13%（95%CI，8-19），中，35%（95%CI，31-38），高，71%（95%CI，50-89）；修订版日内瓦评分的低、中、高临床概率的 PE 患病率分别为：低，9%（95%CI，8-11），中，26%（95%CI，24-28），高，76%（95%CI，69-82）。两分类评分（PE 可能性大或 PE 可能性小）的 PE 患病率为：Wells 评分的低、中、高临床概率分别为 8%（95%CI，6-11）和 34%（95%CI，29-40）；夏洛特评分的低、中、高临床概率分别为 6%（95%CI，3-9）和 23%（95%CI，11-36）。
现有的用于评估 PE 临床可能性的 CPR 具有相似的准确性。然而，现有的评分并不等效，并且各种预测规则和分类方案（三分类与两分类）的选择必须根据 PE 的当地患病率、考虑的患者类型（门诊或住院患者）以及应用的 D-二聚体检测类型来指导。
