Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy.
Department of Biomedical Sciences and Human Oncology, University of Bari Medical School "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy.
Radiol Med. 2021 Dec;126(12):1544-1552. doi: 10.1007/s11547-021-01416-x. Epub 2021 Sep 13.
To assess the percentage of computed tomography pulmonary angiography (CTPA) procedures that could have been avoided by methodical application of the Revised Geneva Score (RGS) coupled with age-adjusted D-dimer cut-offs rather than only clinical judgment in Emergency Department patients with suspected pulmonary embolism (PE).
Between November 2019 and May 2020, 437 patients with suspected PE based on symptoms and D-dimer test were included in this study. All patients underwent to CTPA. For each patient, we retrospectively calculated the age-adjusted D-dimer cut-offs and the RGS in the original version. Finally, CT images were retrospectively reviewed, and the presence of PE was recorded.
In total, 43 (9.84%) CTPA could have been avoided by use of RGS coupled with age-adjusted D-dimer cut-offs. Prevalence of PE was 14.87%. From the analysis of 43 inappropriate CTPA, 24 (55.81%) of patients did not show any thoracic signs, two (4.65%) of patients had PE, and the remaining patients had alternative thoracic findings.
The study showed good prevalence of PE diagnoses in our department using only physician assessment, although 9.84% CTPA could have been avoided by methodical application of RGS coupled with age-adjusted D-dimer cut-offs.
评估在疑似肺栓塞（PE）的急诊科患者中，通过系统应用修订版日内瓦评分（RGS）结合年龄校正 D-二聚体截断值，而不仅仅是临床判断，可避免进行多少例计算机断层肺动脉造影（CTPA）检查。
本研究纳入了 2019 年 11 月至 2020 年 5 月期间基于症状和 D-二聚体检测疑似 PE 的 437 例患者。所有患者均接受了 CTPA 检查。对于每位患者，我们回顾性计算了年龄校正的 D-二聚体截断值和原始版本的 RGS。最后，对 CT 图像进行了回顾性审查，并记录了 PE 的存在。
总共，通过使用 RGS 结合年龄校正的 D-二聚体截断值，可以避免 43（9.84%）例 CTPA。PE 的患病率为 14.87%。从对 43 例不适当的 CTPA 分析中，24（55.81%）例患者没有任何胸部征象，2（4.65%）例患者患有 PE，其余患者有其他胸部发现。
尽管通过系统应用 RGS 结合年龄校正的 D-二聚体截断值可以避免 9.84%的 CTPA，但本研究显示，仅通过医生评估，我们科室的 PE 诊断患病率良好。
