Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
Radiology Division, Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
J Intensive Care Med. 2020 Oct;35(10):1112-1117. doi: 10.1177/0885066618816280. Epub 2018 Dec 16.
Critically ill patients are at high risk for pulmonary embolism (PE). Specific PE prediction rules have not been validated in this population. The present study assessed the Wells and revised Geneva scoring systems as predictors of PE in critically ill patients.
Pulmonary computed tomographic angiograms (CTAs) performed for suspected PE in critically ill adult patients were retrospectively identified. Wells and revised Geneva scores were calculated based on information from medical records. The reliability of both scores as predictors of PE was determined using receiver operating characteristic (ROC) curve analysis.
Of 138 patients, 42 (30.4%) were positive for PE based on pulmonary CTA. Mean Wells score was 4.3 (3.5) in patients with PE versus 2.7 (1.9) in patients without PE ( < .001). Revised Geneva score was 5.8 (3.3) versus 5.1 (2.5) in patients with versus without PE ( = .194). According to the Wells and revised Geneva scores, 56 (40.6%) patients and 49 (35.5%) patients, respectively, were considered as low probability for PE. Of those considered as low risk by the Wells score, 15 (26.8%) had filling defects on CTA, including 2 patients with main pulmonary artery embolism. The area under the ROC curve was 0.634 for the Wells score and 0.546 for the revised Geneva score. Wells score >4 had a sensitivity of 40%, specificity of 87%, positive predictive value of 59%, and negative predictive value of 77% to predict risk of PE.
In this population of critically ill patients, Wells and revised Geneva scores were not reliable predictors of PE.
危重症患者发生肺栓塞（PE）的风险较高。特定的 PE 预测规则尚未在该人群中得到验证。本研究评估了 Wells 和修订版 Geneva 评分系统作为预测危重症患者 PE 的指标。
回顾性确定了疑似危重症成年患者行肺部 CT 肺动脉造影（CTA）的病例。根据病历资料计算 Wells 和修订版 Geneva 评分。采用受试者工作特征（ROC）曲线分析确定这两种评分作为 PE 预测指标的可靠性。
在 138 例患者中，根据肺部 CTA，42 例（30.4%）患者为 PE 阳性。PE 患者的 Wells 评分平均值为 4.3（3.5），而非 PE 患者为 2.7（1.9）（<.001）。修订版 Geneva 评分在 PE 患者中为 5.8（3.3），而非 PE 患者中为 5.1（2.5）（=.194）。根据 Wells 和修订版 Geneva 评分，分别有 56 例（40.6%）和 49 例（35.5%）患者被认为发生 PE 的可能性较低。在 Wells 评分被认为低风险的患者中，有 15 例（26.8%）患者 CTA 上存在充盈缺损，其中包括 2 例主肺动脉栓塞。ROC 曲线下面积为 Wells 评分 0.634，修订版 Geneva 评分 0.546。Wells 评分>4 预测 PE 风险的敏感性为 40%，特异性为 87%，阳性预测值为 59%，阴性预测值为 77%。
在该危重症患者人群中，Wells 和修订版 Geneva 评分不是预测 PE 的可靠指标。
