Turan Onur, Turgut Deniz, Gunay Turkan, Yilmaz Erkan, Turan Ayse, Akkoclu Atila
Chest Disease Department, Faculty of Medicine, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Karabaglar, İzmir, Turkey.
Radiodiagnostics Department, Faculty of Medicine, Dokuz Eylul University, Inciraltı, İzmir, Turkey.
Adv Clin Exp Med. 2017 Mar-Apr;26(2):303-309. doi: 10.17219/acem/35106.
Pulmonary thromboembolism (PE) is a major disease in respiratory emergencies. Thoracic CT angiography (CTA) is an important method of visualizing PE. Because of the high radiation and contrast exposure, the method should be performed selectively in patients in whom PE is suspected.
The aim of the study was to identify the role of clinical scoring systems utilizing CTA results to diagnose PE.
The study investigated 196 patients referred to the hospital emergency service in whom PE was suspected and CTA performed. They were evaluated by empirical, Wells, Geneva and Miniati assessments and classified as low, intermediate and high clinical probability. They were also classified according to serum D-dimer levels. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated and evaluated according to CTA findings.
Empirical scoring was found to have the highest sensitivity, while the Wells system had the highest specificity. When low D-dimer levels and "low probabilty" were evaluated together for each scoring system, the sensitivity was found to be 100% for all methods. Wells scoring with a cut-off score of 4 had the highest specificity (56.1%).
Clinical scoring systems may be guides for patients in whom PE is suspected in the emergency department. The empirical and Wells scoring systems are effective methods for patient selection. Adding evaluation of D-dimer serum levels to the clinical scores could identify patients in whom CTA should be performed. Since CTA can only be used conservatively, the use of clinical scoring systems in conjunction with D-dimer levels can be a useful guide for patient selection.
肺血栓栓塞症（PE）是呼吸急症中的一种主要疾病。胸部CT血管造影（CTA）是可视化PE的重要方法。由于辐射和造影剂暴露量高，该方法应在疑似PE的患者中选择性进行。
本研究的目的是确定利用CTA结果的临床评分系统在诊断PE中的作用。
本研究调查了196名转诊至医院急诊科且疑似PE并接受CTA检查的患者。通过经验性评估、Wells评估法、日内瓦评估法和Miniati评估法对他们进行评估，并分为临床低、中、高概率组。他们还根据血清D-二聚体水平进行分类。根据CTA结果计算并评估敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
发现经验性评分的敏感性最高，而Wells系统的特异性最高。当对每个评分系统同时评估低D-二聚体水平和“低概率”时，发现所有方法的敏感性均为100%。截断分数为4的Wells评分具有最高的特异性（56.1%）。
临床评分系统可为急诊科疑似PE的患者提供指导。经验性评分系统和Wells评分系统是有效的患者选择方法。将D-二聚体血清水平评估添加到临床评分中可以识别出应进行CTA检查的患者。由于CTA只能谨慎使用，将临床评分系统与D-二聚体水平结合使用可为患者选择提供有用的指导。
