Tang Luojia, Hu Yundi, Min Min, Gu Jianyong, Pan Dong, Lin Xiaolei, Tong Chaoyang
Emergency Department of Zhongshan Hospital Fudan University Shanghai China.
School of Data Science Fudan University Shanghai China.
Health Sci Rep. 2024 Aug 20;7(8):e70003. doi: 10.1002/hsr2.70003. eCollection 2024 Aug.
Pulmonary embolism (PE) is among the most severe cardiovascular disorders worldwide. Timely and appropriate diagnosis of PE remains an important step in reducing PE related mortality and morbidity.
In this retrospective single-center cohort study, we comprehensively compared the screening performances of several clinical scoring systems (Wells score [WS], Revised Geneva score [RGS], WS + d-Dimer [D-D], RGS + D-D, WS + PE rule-out criteria [PERC] and RGS + PERC) among PE suspected patients. Failure rates across different PE severity grades as well as overall sensitivity/specificity were considered in evaluating each screening strategy.
A total of 3437 patients were included in this study and 698 of them were diagnosed with PE. Patients with and without PE were similar in demographics, while significantly different in respiration-related characteristics. Compared with WS or RGS alone, Integrating PERC or D-D with WS or RGS significantly decreased the failure rates across all PE severity grades, and increased the overall sensitivity from 88.5% and 87.2% to 96.3% and 94.8% (D-D) to 99.4% and 99.6% (PERC), respectively. However, compared with other four scoring approaches, using WS or RGS alone increased the specificity from 8.3% and 7.2%, 38.3% and 21.3%, to 63.5% and 34.8%, respectively, and increased the AUC from 0.54 to 0.54, 0.70 and 0.69, to 0.8 and 0.76, respectively. In general, all screening approaches achieved better performances among PE patients with respiratory distress compared to those without respiratory distress.
Combining PERC or D-D with WS or RGS, and the presence of respiratory distress provide significantly better PE rule-out performances.
肺栓塞（PE）是全球最严重的心血管疾病之一。及时、准确地诊断PE仍然是降低PE相关死亡率和发病率的重要环节。
在这项回顾性单中心队列研究中，我们全面比较了几种临床评分系统（Wells评分[WS]、修订版日内瓦评分[RGS]、WS+d-二聚体[D-D]、RGS+D-D、WS+PE排除标准[PERC]和RGS+PERC）在疑似PE患者中的筛查性能。在评估每种筛查策略时，考虑了不同PE严重程度等级的失败率以及总体敏感性/特异性。
本研究共纳入3437例患者，其中698例被诊断为PE。有PE和无PE的患者在人口统计学特征上相似，但在呼吸相关特征上有显著差异。与单独使用WS或RGS相比，将PERC或D-D与WS或RGS相结合可显著降低所有PE严重程度等级的失败率，并将总体敏感性分别从88.5%和87.2%提高到96.3%和94.8%（D-D）以及99.4%和99.6%（PERC）。然而，与其他四种评分方法相比，单独使用WS或RGS可将特异性分别从8.3%和7.2%、38.3%和21.3%提高到63.5%和34.8%，并将曲线下面积（AUC）分别从0.54提高到0.54、0.70和0.69、0.8和0.76。总体而言，与无呼吸窘迫的PE患者相比，所有筛查方法在有呼吸窘迫的PE患者中表现更好。
将PERC或D-D与WS或RGS相结合，以及存在呼吸窘迫可显著提高PE的排除性能。
