Diagnostic Value Of The Simplified Geneva Score Combined With D-dimer In Pulmonary Thromboembolism Of Inpatients

Objective:To evaluate the predictive value of the simplified Geneva score,D-dimer(D-D),and the combination of the two for hospitalized patients with suspected pulmonary thromboembolism(PTE),and to explore an effective clinical prediction method for suspected pulmonary embolism.The diagnosis of suspected pulmonary embolism in hospitals is helpful.Methods:The subjects were hospitalized patients with suspected PTE from December 2016 to December 2017 in the First Affiliated Hospital of Shanxi Medical University.All patients were followed by spiral CT pulmonary angiography(CTPA)and/or pulmonary ventilation/perfusion(V/Q)scans,and D-dimer(D-D)tests.Patients were collected on the first day of admission for their clinical data and simplified the Geneva score(SGS)to assess the possibility of the patient's illness;according to the SGS two classification is divided into PTE possible group and PTE impossible group.The D-D>500?g/L is a positive diagnostic criterion.If the patient is ?50 years old with age-adjusted D-dimer(AADD),age ?(age×10)?g/L is a positive diagnosis;according to the test results D-D positive and negative groups.Positive results from CTPA and/or V/Q scans are the gold standard for the diagnosis of PTE.Calculate the true positive rate,positive predictive value,positive likelihood ratio,true negative rate,negative predictive value,negative likelihood ratio and Youden index of each group of SGS,DD and SGS+DD,and evaluate the three methods for suspected PTE patients in hospital Diagnostic predictive value.Results:Among 102 suspected PTE patients,valid cases were included,including 63 males(61.8%)and 39 females(38.2%).The average age was(61.71±16.43)years.Among the 31 patients diagnosed by CTPA or V/Q,the diagnosis rate was 30.4%,male 16(51.6%),female 15(48.4%),mean age(61.42±16.07)years old.Predictive value of SGS in patients with suspected PTE: The results of SGS in 102 patients with suspected PTE were 42 cases with PTE,60 cases with PTE impossible,25 cases with PTE diagnosed by gold standard,6 cases with impossible,6 cases with true positive rate and true negative.The rate,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio,Youden index,false negative rate were 80.6%,76.1%,59.5%,90.0%,3.37,0.25,0.567,and 19.4%.The predictive value of D-D for patients with suspected PTE: Among the 102 patients with suspected PTE hospitalization,55 were positive,29 were diagnosed with PTE,47 were negative,and 2 were diagnosed with PTE.The true positive rate,true negative rate,positive predictive value,negative predictive value,positive likelihood ratio The negative likelihood ratio,Youden index,and false negative rate were 93.5%,63.4%,52.7%,95.7%,2.55,0.10,0.569,and 6.5%,respectively.Predictive value of SGS+D-D in patients with suspected PTE: The SGS impossible group and the DD-negative group were combined,the true positive rate was 93.5%,and the negative predictive value was as high as 95.9%.Compared with the negative result of the single one,the negative likelihood ratio was reduced to 0.10,and the diagnostic value was further improved;SGS may be combined with DD positive group,the true negative rate(93.0%),positive predictive value(82.1%),Youden index(0.67)increased,compared with a single positive,positive likelihood ratio(10.54)liters high.The positive rates of SGS,D-D,SGS+D-D positive and SGS+D-D negative test were statistically significant(P<0.05).Conclusion:1.Simplifying the content of the Geneva score does not require special examination.The evaluation index is objective and easy to use and can be used for the preliminary assessment of the possibility of clinically suspected PTE patients.The predictive value of a positive result(PTE possible)has some limitations,and the negative result(PTE impossible)has a higher clinical exclusion value.2.There are many influencing factors in the detection of D-dimer.The true positive rate of patients with suspected PTE is high,but the true-negative rate is poor.Negative D-D results can serve as an important reference for the diagnosis of suspected PTE.3.Simplification of the Geneva score PTE potential group + D-dimer positive predictive value of the possibility of PTE is significantly higher than its individual indicators,suggesting that PTE diagnosis examination.Simplification of the Geneva score PTE the negative predictive value for the negative group + DD is 95.9%.The elimination of the diagnostic value is even higher than that of the DD alone.For outpatients and primary hospitals that do not have diagnostic testing equipment,they can assist doctors to judge and have larger clinical values.