Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1
5-Year Impact Factor – 2.2
Scopus CiteScore – 3.4 (CiteScore Tracker 3.7)
Index Copernicus  – 161.11; MNiSW – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

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Advances in Clinical and Experimental Medicine

2017, vol. 26, nr 2, March-April, p. 303–309

doi: 10.17219/acem/35106

Publication type: original article

Language: English

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The contribution of clinical assessments to the diagnostic algorithm of pulmonary embolism

Onur Turan1,A,B,C,D,E,F, Deniz Turgut2,A,B,C, Turkan Gunay3,B,C,D, Erkan Yilmaz2,A,B,C, Ayse Turan4,D,E,F, Atila Akkoclu5,A,B,C

1 Chest Disease Department, Faculty of Medicine, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Karabaglar, İzmir, Turkey

2 Radiodiagnostics Department, Faculty of Medicine, Dokuz Eylul University, Inciraltı, İzmir, Turkey

3 Public Health Department, Faculty of Medicine, Dokuz Eylul University, Inciraltı, İzmir, Turkey

4 Menemen State Hospital, Menemen, İzmir, Turkey

5 Chest Disease Department, Faculty of Medicine, Dokuz Eylul University, Inciraltı, İzmir, Turkey

Abstract

Background. Pulmonary thromboembolism (PE) is a major disease in respiratory emergencies. Thoracic CT angiography (CTA) is an important method of visualizing PE. Because of the high radiation and contrast exposure, the method should be performed selectively in patients in whom PE is suspected.
Objectives. The aim of the study was to identify the role of clinical scoring systems utilizing CTA results to diagnose PE.
Material and Methods. The study investigated 196 patients referred to the hospital emergency service in whom PE was suspected and CTA performed. They were evaluated by empirical, Wells, Geneva and Miniati assessments and classified as low, intermediate and high clinical probability. They were also classified according to serum D-dimer levels. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated and evaluated according to CTA findings.
Results. Empirical scoring was found to have the highest sensitivity, while the Wells system had the highest specificity. When low D-dimer levels and “low probabilty” were evaluated together for each scoring system, the sensitivity was found to be 100% for all methods. Wells scoring with a cut-off score of 4 had the highest specificity (56.1%).
Conclusion. Clinical scoring systems may be guides for patients in whom PE is suspected in the emergency department. The empirical and Wells scoring systems are effective methods for patient selection. Adding evaluation of D-dimer serum levels to the clinical scores could identify patients in whom CTA should be performed. Since CTA can only be used conservatively, the use of clinical scoring systems in conjunction with D-dimer levels can be a useful guide for patient selection.

Key words

pulmonary embolism, clinical scoring systems, Wells score

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