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KMID : 0383820080640040266
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Tuberculosis and Respiratory Diseases
2008 Volume.64 No. 4 p.266 ~ p.271
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Assessment of Two Clinical Prediction Models for a Pulmonary Embolism in Patients with a Suspected Pulmonary Embolism
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Park Jae-Seok
Choi Won-Il
Min Bo-Ram
Park Jie-Hae
Chae Jin-Nyeong
Jeon Young-June
Yu Ho-Jung
Kim Ji-Young
Kim Gyoung-Ju
Ko Sung-Min
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Abstract
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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
(κ 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. (Tuberc Respir Dis 2008;64:
266-271)
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KEYWORD
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Pulmonary embolism, Diagnosis, Computed tomography
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