Tuberc Respir Dis > Volume 64(4); 2008 > Article
Tuberculosis and Respiratory Diseases 2008;64(4):266-271.
DOI:    Published online April 1, 2008.
Assessment of Two Clinical Prediction Models for a Pulmonary Embolism in Patients with a Suspected Pulmonary Embolism.
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.
2Department of Diagnostic Radiology, Keimyung University School of Medicine, Daegu, Korea.
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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