The Diagnostic Value Of The Simplified Wells Score,Revised Geneva Score And 4PEPS For Pulmonary Embolism

Objective:To investigate the diagnostic value of traditional clinical scoring models(simplified Wells score,revised Geneva score)and conventional ancillary laboratory indicators alone and in combination for the diagnosis of PE(pulmonary embolism,PE),and to compare them with the newly proposed 4PEPS score(the 4-level pulmonary embolism probability score,4PEPS).The aim is to derive the best predictive method to be applied in clinical practice.Methods:Retrospective analysis of 219 patients with suspected PE admitted to Shanxi Provincial People’s Hospital from May 2020 to May 2022,using the results of CTPA(computed tomography pulmonary angiography,CTPA)as the gold standard and dividing the patients into PE and non-PE groups and scoring them using clinical scoring models.The positive predictive value,negative predictive value,sensitivity,specificity,accuracy and Youden index of the simplified Wells score,the revised Geneva score,their combination with D-dimer and 4PEPS scores for predicting PE were analysed.The subject working characteristic curves were plotted and the area under the curve(AUC)was calculated to assess the performance of traditional clinical scoring models and their combination with D-dimer in predicting PE,and compared to the newly proposed 4PEPS score.Results:1.79 patients(36.1%)were diagnosed with PE by CTPA among 219 patients and 140 patients with non-PE.2.There was no statistically significant difference in age,gender,heart rate,active tumour stage,haemoptysis,hypertension,coronary artery disease,arrhythmia,psychiatric disease,history of chronic lung disease and previous cerebral infarction in the two groups compared with each other(P>0.05),but there was a statistically significant difference in the high incidence of PE or DVT history,braking or surgery within 1 month and unilateral lower limb oedema pain in the pulmonary embolism group compared with the non-pulmonary embolism group(P<0.05).3.For the data in this sample,the optimal cut-off point for the diagnosis of PE with D-dimer was 0.47 mg/L.4.The D-dimer and platelet distribution width levels were higher in the PE group,the difference between the low oxygen partial pressure level and the non-PE group was statistically significant(P<0.05),and the difference in mean platelet volume between the two groups was not statistically significant(P>0.05).The positive predictive value(49.3%),negative predictive value(87.3%),sensitivity(87.3%),specificity(49.3%),Youden index(0.36),accuracy(63.0%)and kappa(0.314)values of plasma D-dimer for PE prediction were higher than those of platelet distribution width and partial pressure of oxygen level for PE prediction in the three auxiliary labs.predictive value.5.The positive predictive values of simplified Wells score,revised Geneva score,D-dimer combined with simplified Wells score,D-dimer combined with revised Geneva score,and 4PEPS for the diagnosis of PE was 62.0%,52.4%,67.6%,59.1%,and 55.1%,respectively;Negative predictive values were 78.6%,74.1%,77.3%,73.9% and 79.3%,respectively;Sensitivity was 62.0%,55.7%,55.7%,49.4% and 68.4%,respectively;The specificity was 78.6%,71.4%,85.0%,80.7% and 68.6%,respectively;The accuracy were72.6%,65.8%,74.4%,69.4% and 68.5%,respectively;Youden index was 0.41,0.27,0.41,0.30 and 0.37,respectively;The Kappa values were 0.406,0.268,0.423,0.312 and0.312,respectively.6.The AUC for D-dimer,simplified Wells score,revised Geneva score,D-dimer combined with simplified Wells score,D-dimer combined with revised Geneva score,and4 PEPS diagnostic PE were 0.734,0.735,0.688,0.790,0.743,and 0.683,respectively.The differences in AUC between D-dimer combined with simplified Wells score and simplified Wells score,revised Geneva score,4PEPS score,and D-dimer combined with revised Geneva score were statistically significant(P<0.05).the differences in AUC between D-dimer combined with revised Geneva score and revised Geneva score were statistically significant(P<0.05),while all other differences in AUC between the two comparisons were not statistically significant(P>0.05).Conclusion:1.In the low probability group of patients hospitalised with suspected PE,the diagnostic value of 4PEPS was modest.2.Among the ancillary laboratory tests,partial pressure of oxygen,platelet distribution width and mean platelet volume are much less valuable than D-dimer for the diagnosis of PE,and have little significance for the diagnosis of PE.3.The positive predictive value,specificity,accuracy and Youden index of the three clinical scores were higher than those of the other two scores compared to the simplified Wells score.4 PEPS had the highest sensitivity and negative predictive value.The Revised Geneva score was not high in all evaluation criteria.Overall,the simplified Wells score had the best diagnostic value for PE,and the revised Geneva score and the4 PEPS score were inferior to the simplified Wells score.4.Consistency analysis of diagnostic tests for all diagnostic methods(D-dimer,simplified Wells score,revised Geneva score,D-dimer + simplified Wells score,D-dimer+ revised Geneva score,4PEPS score)showed high agreement with the gold standard(kappa values >0.6).5.Among all diagnostic methods(D-dimer,simplified Wells score,revised Geneva score,D-dimer + simplified Wells score,D-dimer + revised Geneva score,4PEPS score),D-dimer had the highest negative predictive value,sensitivity;simplified Wells score,D-dimer + simplified Wells score had the Youden index was the highest;D-dimer +simplified Wells score had the highest positive predictive value,specificity,accuracy,kappa value and AUC.Overall,all six diagnostic methods had some value in diagnosing PE,with the D-dimer + simplified Wells score having the highest diagnostic value.6.A history of PE or DVT,braking or surgery within 1 month,and a high incidence of unilateral lower limb oedema and pain are risk factors for PE.7.The diagnostic values of simplified Wells score and revised Geneva score were improved when they combined with D-dimer.