Comparison of the accuracy of four diagnostic prediction rules for pulmonary embolism in patients admitted to the emergency department

• Published in: Revista portuguesa de cardiologia 2024-10, Vol.43 (10), p.551-559
• Main Authors: Valente Silva, Beatriz, Jorge, Cláudia, Plácido, Rui, Nobre Menezes, Miguel, Mendonça, Carlos, Luísa Urbano, Maria, Rigueira, Joana, G. Almeida, Ana, Pinto, Fausto J.
• Format: Article
• Language: English
• Subjects: Aged; Angiotomografia computorizada pulmonar; Clinical Decision Rules; Computed tomography pulmonary angiography; D-dimer; D-dímeros; Embolia pulmonar; Emergency Service, Hospital; Female; Fibrin Fibrinogen Degradation Products - analysis; Humans; Male; Middle Aged; Predictive Value of Tests; Pulmonary embolism; Pulmonary Embolism - diagnosis; Pulmonary Embolism - diagnostic imaging; Retrospective Studies
• ISSN: 0870-2551; 2174-2030; 2174-2030
• DOI: 10.1016/j.repc.2024.02.006

Ruling out pulmonary embolism (PE) through a combination of clinical assessment and D-dimer level can potentially avoid excessive use of computed tomography pulmonary angiography (CTPA). We aimed to compare the diagnostic accuracy of the standard approach based on the Wells and Geneva scores combined with a standard D-dimer cut-off (500 ng/ml), with three alternative strategies (age-adjusted and the YEARS and PEGeD algorithms) in patients admitted to the emergency department (ED) with suspected PE. Consecutive outpatients admitted to the ED who underwent CTPA due to suspected PE were retrospectively assessed. Sensitivity, specificity, positive and negative predictive values, likelihood ratios and diagnostic odds ratios were calculated and compared between the different diagnostic prediction rules. We included 1402 patients (mean age 69±18 years, 54% female), and PE was confirmed in 25%. Compared to the standard approach (p