Study Of Acute Pulmonary Thromboembolism Acquired Risk Factors And Risk Stratification

Objective To study acute pulmonary thromboembolism( ATPE) acquired risk factors related to for disease formation;Clinical diagnostic evaluation score, Wells score, the Revised-Geneva score sensitivity for the diagnosis of acute pulmonary thromboembolism, specificity, the rate of misdiagnosis and missed diagnosis rate, positive/negative predictive value, positive/negative likelihood, Youden index situation;The clinical value of different scoring methods in risk stratification.Methods Deputy Director of Cardiology by three experienced doctors each of 640 cases of suspicious APTE or diagnose APTE patients were evaluated in accordance with the clinical diagnostic evaluation score,Wells score,Revised-Gene va score,conducted evaluation of clinical probability of pulmonary embolism,and according to the level of the score in patients divided into low, medium,high probability.Final comprehensive evaluation based on the results of three experts were divided into the 549 cases diagnosed APTE group,APTE group and exclude 91 cases, patients are diagnosed and then divided into groups according to age group including elderly(age ≥60 years) 299 cases, Non- elderly(18 years old ≤ age <60 years old) 250 cases, discussion between the two groups of acquired risk factors in patients with APTE constituent ratio.Through comprehensive evaluation sensitivity, specificity, misdiagno-sis rate, missed diagnosis rate, positive/negative predictive value, positive/,negative likelihood ratio, Youden index and indicators of each scoring system confirmed the effectiveness of the exclusion or diagnosis of APTE.By comparing the area under the ROC curve scoring method, the difference overall diagnostic performance of each scoring system.Results Non- elderly patients acquired risk factors by order of venous inflammation 87(34.80%) cases,hypertension 41(16.40%) cases, surgery(nearly four weeks braking) 30(12.00%)cases,trauma brake 14(5.60%)cases,cancer and coronary heart disease are 11(4.4%)cases,after cesarean 10(4.00%) cases;elderly patients acquired risk factors by order of elderly,Hypertension 120(40.13%) cases, venous inflammation 78(26.08%)cases,coronary heart disease 56(18.73%) case, cerebrovascular disease 36(12.04%) cases,COPD 32(10.7%) cases,surgery(nearly four weeks braking) 27(9.03%) cases.Clinical score method diagnosis rate in height possible group and low possible group were 89.85%,75.14%;Wells score method diagnosis rate in height possible group and,moderate possible group, low possible group were 90.22% 、 90.03% 、 57.14%;Revised-Geneva score method diagnosis rate in height possible group and,moderate possible group,low possible group were 88.89%、85.40%、82.08%;The area under the curve of the three scoring methods were Clinical scores method 0.665±0.33,Wells score method 0.666±0.34, Revised-Geneva scores method 0.583±0.33。Conclusions 1. There are age differences acquired risk factors for acute pulmonary thrombo embolism in patients,Non-elderly patients with venous inflammation,hypertension, brake;Elderly patients elderly patients with chronic diseases. 2. APTE diagnosis rate evaluation in low possibility group,Wells score and Revised-Geneva score method have the same value. 3. Clinical evaluation score in the exclusion,or diagnosis of acute pulmonary thromboembolism in sensitivity, accuracy, positive likelihood ratio were better than Wells score and the Revised-Geneva score 4. Clinical score and Welll score in acute pulmonary thromboembolism risk stratification, diagnosis comprehensive efficiency better than Revised-Geneva score.