Centre Hospitalier d'Agen-Nérac, Site St Esprit, 21 route de Villeneuve, 47923 Agen, France.
Medical Practice, 748 avenue du Général Leclerc, 47000 Agen, France.
Thromb Res. 2020 Dec;196:120-126. doi: 10.1016/j.thromres.2020.07.026. Epub 2020 Aug 14.
Comparison of the Wells score and the revised Geneva score as a tool to predict pulmonary embolism in outpatients over 65 years of age.
The incidence and mortality of pulmonary embolism (PE) is high in the elderly. The Wells score (SW) and the revised Geneva score (RGS) have been validated in patient populations with a large age range. The aim of this study was to compare the predictive accuracy of these two scores in diagnosis of PE in patients over 65 years of age.
A prospective multicentre study (nine French and three Belgian centres) was conducted at the same time as the PERCEPIC study. A total of 1757 patients admitted with suspected PE were included and divided into two groups according to age (≥65 years or <65 years). The pre-test probability of PE was assessed prospectively for the RGS. The SW was calculated retrospectively. The predictive accuracy of the two scores was compared by the area under the curve (AUC) of the ROC curves.
The overall prevalence of PE was 11.3%. The prevalence among patients aged ≥65 in the low, moderate and high pre-test probability groups, evaluated using the WS and was respectively 13.5% (CI 95%: CI 9.9-17.3), 28.2% (CI 22.1-34.3), 50% (CI 26-74) and 8.1% (CI 3.2-12.9), 22.3% (CI 18.2-26.3), 43.7% (CI 25.6-61.9) using the RGS. The AUC for the WS and RGS for patients aged ≥65 was 0.632 (CI 0.574-0.691) and 0.610 (CI 0.555-0.666). The difference between the AUCs was not statistically significant (p = .441).
In the population for this study, the WS and RGS have the same PE diagnostic accuracy in patients over age 65. This result should be validated in a prospective study that directly compares these scores.
Wells 评分与修订版 Geneva 评分在预测 65 岁以上门诊患者肺栓塞中的比较。
肺栓塞（PE）在老年人中的发病率和死亡率较高。Wells 评分（SW）和修订版 Geneva 评分（RGS）已在年龄范围较大的患者人群中得到验证。本研究的目的是比较这两种评分在诊断 65 岁以上患者 PE 中的预测准确性。
同时进行了一项前瞻性多中心研究（9 个法国和 3 个比利时中心），作为 PERCEPIC 研究的一部分。共纳入 1757 例疑似 PE 患者，并根据年龄（≥65 岁或＜65 岁）分为两组。前瞻性评估 RGS 的 PE 术前概率。回顾性计算 SW。通过 ROC 曲线下面积（AUC）比较两种评分的预测准确性。
PE 的总体患病率为 11.3%。在低、中、高术前概率组中，≥65 岁患者的患病率分别为 13.5%（95%CI：9.9-17.3）、28.2%（95%CI：22.1-34.3）、50%（95%CI：26-74）和 8.1%（95%CI：3.2-12.9）、22.3%（95%CI：18.2-26.3）、43.7%（95%CI：25.6-61.9），使用 RGS。年龄≥65 岁患者的 WS 和 RGS 的 AUC 分别为 0.632（95%CI：0.574-0.691）和 0.610（95%CI：0.555-0.666）。AUC 之间的差异无统计学意义（p=0.441）。
在本研究人群中，SW 和 RGS 在预测 65 岁以上患者的 PE 方面具有相同的准确性。这一结果应在一项直接比较这两种评分的前瞻性研究中得到验证。
