Obradović Dušanka, Joveš Biljana, Pena Karan Slobodanka, Stefanović Srdjan, Ivanov Igor, Vukoja Marija
Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
Medical Faculty Novi Sad, University of Novi Sad, Novi Sad, Serbia.
Clin Respir J. 2016 Nov;10(6):784-790. doi: 10.1111/crj.12291. Epub 2015 Apr 6.
Determining clinical probability of pulmonary embolism (PE) with Wells scoring system is the first step towards diagnosis of PE. Definitive diagnosis of PE is confirmed by computed tomography pulmonary angiography (CTPA).
This was a prospective study on 80 patients referred to the Institute for Pulmonary Diseases of Vojvodina with suspected PE between April 2010 and August 2012. Clinical probability of PE was determined according to the Wells and modified Wells scoring system. CTPA was performed in 60 patients. The degree of pulmonary vascular obstruction was quantified by the Qanadli index.
Low clinical probability of PE was present in one patient (1.6%), moderate in 43 (71.6%) and high in 16 (26.6%) patients. PE was confirmed in 50 (83.3%) patients. There were 21 patients (42%) whose Quanadli index was <25%, 18 (36%) between 25%-50%, while Quanadli index was ≥50 in 11 patients (22%). When compared to CTPA findings, modified Wells scoring system showed 90% sensitivity [95% confidence interval (CI) 78.2%-96.6%], and 20% specificity (95% CI 3.11%-55.6%), positive predictive value (PPV) 84.9% (95% CI 72.4%-93.2%) and negative predictive value (NPV) 28.6% (95% CI 4.5%-70.7%). There was weak positive correlation between Wells score and Quanadli index (r = 0.14; P = 0.29), without statistical significance. Wells score was significantly higher in haemodynamically unstable than in haemodynamically stable patients (6.8 vs 5.6, P = 0.014). There was no statistically significant difference between the values of Quanadli index in these two groups (31.33% vs 26.64%, P = 0.062).
Modified Wells criteria have high sensitivity but low specificity in PE diagnostics. The Wells score does not correlate well with the Quanadli index.
使用Wells评分系统确定肺栓塞（PE）的临床概率是PE诊断的第一步。PE的确诊通过计算机断层扫描肺动脉造影（CTPA）来证实。
这是一项对2010年4月至2012年8月间转诊至伏伊伏丁那肺病研究所、疑似患有PE的80例患者进行的前瞻性研究。根据Wells和改良Wells评分系统确定PE的临床概率。60例患者接受了CTPA检查。通过Qanadli指数对肺血管阻塞程度进行量化。
1例患者（1.6%）PE临床概率低，43例（71.6%）为中度，16例（26.6%）为高度。50例（83.3%）患者确诊为PE。21例患者（42%）的Qanadli指数<25%，18例（36%）在25% - 50%之间，11例患者（22%）的Qanadli指数≥50%。与CTPA检查结果相比，改良Wells评分系统显示敏感性为90% [95%置信区间（CI）78.2% - 96.6%]，特异性为20%（95% CI 3.11% - 55.6%），阳性预测值（PPV）为84.9%（95% CI 72.4% - 93.2%），阴性预测值（NPV）为28.6%（95% CI 4.5% - 70.7%）。Wells评分与Qanadli指数之间存在弱正相关（r = 0.14；P = 0.29），无统计学意义。血流动力学不稳定患者的Wells评分显著高于血流动力学稳定患者（6.8对5.6，P = 0.014）。两组患者的Qanadli指数值无统计学差异（31.33%对26.64%，P = 0.062）。
改良Wells标准在PE诊断中具有高敏感性但低特异性。Wells评分与Qanadli指数相关性不佳。
