Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
J Emerg Med. 2020 Mar;58(3):385-390. doi: 10.1016/j.jemermed.2019.11.039. Epub 2020 Jan 19.
Clinical scores have been proposed to stratify the risk of pulmonary thromboembolism (PTE), although this approach suffers a low specificity and the unavoidable need for computed tomography pulmonary angiography (CTPA) scans.
Our study aimed to investigate a simple modification to the already validated Wells' score to improve its diagnostic accuracy in the emergency department (ED).
We retrospectively reviewed all CTPA scans performed in the ED setting to rule out PTE over a 1-year (2017) period. Clinical variables potentially associated with PTE were assessed to improve diagnostic accuracy of the Wells' score, thus introducing a modified Wells' score (mWells).
Four thousand four hundred thirteen CTPAs were identified, of which 504 were for suspected PTE. The prevalence of PTE was 23.9%. Among clinical data, only peripheral capillary oxygen saturation was consistently correlated with PTE at univariate (odds ratio 2.75 [95% confidence interval 1.61-4.73]) and multivariate (odds ratio 3.78 [95% confidence interval 2.13-6.72]) logistic regression analysis. The mWells' score had a higher area under the receiver operating characteristic curve compared with the original Wells' score: 0.71 (95% confidence interval 0.67-0.75) vs. 0.65 (95% confidence interval 0.61-0.69) (p < .01) and improved diagnostic accuracy.
Current clinical stratification tools for PTE are characterized by low specificity, leading to an overuse of CTPA. mWells', rather than Wells', score showed a better predictive performance of PTE detection. Our results suggest that current diagnostic pathway for PTE may be improved by simple adjustments (i.e., mWells') of clinical prediction scores.
临床评分被提出用于分层肺血栓栓塞症（PTE）的风险，尽管这种方法特异性低，且不可避免地需要进行计算机断层肺动脉造影（CTPA）扫描。
我们的研究旨在探讨对已验证的 Wells 评分进行简单修改，以提高其在急诊科（ED）的诊断准确性。
我们回顾性审查了在 ED 环境中进行的所有 CTPA 扫描，以排除 1 年内（2017 年）的 PTE。评估与 PTE 相关的潜在临床变量，以提高 Wells 评分的诊断准确性，从而引入改良的 Wells 评分（mWells）。
共确定了 4413 例 CTPA，其中 504 例用于疑似 PTE。PTE 的患病率为 23.9%。在临床数据中，只有外周毛细血管血氧饱和度在单变量（优势比 2.75 [95%置信区间 1.61-4.73]）和多变量（优势比 3.78 [95%置信区间 2.13-6.72]）逻辑回归分析中与 PTE 一致相关。mWells 评分的受试者工作特征曲线下面积（AUC）高于原始 Wells 评分：0.71（95%置信区间 0.67-0.75）vs.0.65（95%置信区间 0.61-0.69）（p<.01），且诊断准确性提高。
目前用于 PTE 的临床分层工具的特异性较低，导致 CTPA 的过度使用。mWells 评分而不是 Wells 评分显示出更好的 PTE 检测预测性能。我们的结果表明，通过对临床预测评分进行简单调整（即 mWells），可能会改善 PTE 的当前诊断途径。
