Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland.
Clinical Research Center, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
J Thromb Haemost. 2017 Sep;15(9):1764-1769. doi: 10.1111/jth.13770. Epub 2017 Aug 17.
Essentials The simplified Geneva score allows easier pretest probability assessment of pulmonary embolism (PE). We prospectively validated this score in the ADJUST-PE management outcome study. The study shows that it is safe to manage patients with suspected PE according to this score. The simplified Geneva score is now ready for use in routine clinical practice.
Background Pretest probability assessment by a clinical prediction rule (CPR) is an important step in the management of patients with suspected pulmonary embolism (PE). A limitation to the use of CPRs is that their constitutive variables and corresponding number of points are difficult to memorize. A simplified version of the Geneva score (i.e. attributing one point to each variable) has been proposed but never been prospectively validated. Aims Prospective validation of the simplified Geneva score (SGS) and comparison with the previous version of the Geneva score (GS). Methods In the ADJUST-PE study, which had the primary aim of validating the age-adjusted D-dimer cut-off, the SGS was prospectively used to determine the pretest probability in a subsample of 1621 study patients. Results Overall, PE was confirmed in 294 (18.1%) patients. Using the SGS, 608 (37.5%), 980 (60.5%) and 33 (2%) were classified as having a low, intermediate and high clinical probability. Corresponding prevalences of PE were 9.7%, 22.4% and 45.5%; 490 (30.1%) patients with low or intermediate probability had a D-dimer level below 500 μg L and 653 (41.1%) had a negative D-dimer test according to the age-adjusted cut-off. Using the GS, the figures were 491(30.9%) and 650 (40.9%). None of the patients considered as not having PE based on a low or intermediate SGS and negative D-dimer had a recurrent thromboembolic event during the 3-month follow-up. Conclusions The use of SGS has similar efficiency and safety to the GS in excluding PE in association with the D-dimer test.
目的 采用临床预测规则（CPR）进行的术前概率评估是疑似肺栓塞（PE）患者管理的重要步骤。CPR 的一个局限性在于其构成变量及其对应的点数难以记忆。已经提出了日内瓦评分的简化版本（即每个变量赋予 1 分），但从未进行前瞻性验证。 方法 在 ADJUST-PE 研究中，该研究的主要目的是验证年龄校正 D-二聚体截止值，前瞻性地使用 SGS 确定了 1621 例研究患者的亚组的术前概率。 结果 总体而言，294 例（18.1%）患者确诊为 PE。使用 SGS，608 例（37.5%）、980 例（60.5%）和 33 例（2%）被归类为低、中和高临床可能性。相应的 PE 患病率为 9.7%、22.4%和 45.5%；490 例（30.1%）低或中概率患者的 D-二聚体水平低于 500μg/L，653 例（41.1%）根据年龄校正的截止值进行 D-二聚体检测呈阴性。使用 GS，相应的数值分别为 491 例（30.9%）和 650 例（40.9%）。根据低或中 SGS 和阴性 D-二聚体，没有考虑为非 PE 的患者在 3 个月的随访中没有发生复发性血栓栓塞事件。 结论 在结合 D-二聚体检测使用 SGS 排除 PE 方面，其效率和安全性与 GS 相似。
