| Assessment of Two Clinical Prediction Models for a Pulmonary Embolism in Patients with a Suspected Pulmonary Embolism. |
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Jae Seok Park, Won Il Choi, Bo Ram Min, Jie Hae Park, Jin Nyeong Chae, Young June Jeon, Ho Jung Yu, Ji Young Kim, Gyoung Ju Kim, Sung Min Ko |
1Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea. wichoi@dsmc.or.kr
2Department of Diagnostic Radiology, Keimyung University School of Medicine, Daegu, Korea. |
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| Abstract |
BACKGROUND
Estimation of the probability of a patient having an acute pulmonary embolism (PE) for patients with a suspected PE are well established in North America and Europe. However, an assessment of the prediction rules for a PE has not been clearly defined in Korea. The aim of this study is to assess the prediction rules for patients with a suspected PE in Korea. METHODS: We performed a retrospective study of 210 inpatients or patients that visited the emergency ward with a suspected PE where computed tomography pulmonary angiography was performed at a single institution between January 2005 and March 2007. Simplified Wells rules and revised Geneva rules were used to estimate the clinical probability of a PE based on information from medical records. RESULTS: Of the 210 patients with a suspected PE, 49 (19.5%) patients had an actual diagnosis of a PE. The proportion of patients classified by Wells rules and the Geneva rules had a low probability of 1% and 21%, an intermediate probability of 62.5% and 76.2%, and a high probability of 33.8% and 2.8%, respectively. The prevalence of PE patients with a low, intermediate and high probability categorized by the Wells rules and Geneva rules was 100% and 4.5% in the low range, 18.2% and 22.5% in the intermediate range, and 19.7% and 50% in the high range, respectively. Receiver operating characteristic curve analysis showed that the revised Geneva rules had a higher accuracy than the Wells rules in terms of detecting PE. Concordance between the two prediction rules was poor (kappa coefficient=0.06). CONCLUSION: In the present study, the two prediction rules had a different predictive accuracy for pulmonary embolisms. Applying the revised Geneva rules to inpatients and emergency ward patients suspected of having PE may allow a more effective diagnostic process than the use of the Wells rules. |
| Key Words:
Pulmonary embolism, Diagnosis, Computed tomography |
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