Assessing clinical probability of pulmonary embolism: Prospective validation of the simplified Geneva score

H. Robert-Ebadi; K. Mostaguir; M. M. Hovens; M. Kare; F. Verschuren; P. Girard; M. V. Huisman; F. Moustafa; P. W. Kamphuisen; H. R. Buller; M. Righini; G. Le Gal

doi:10.1111/jth.13770

Assessing clinical probability of pulmonary embolism: Prospective validation of the simplified Geneva score

H. Robert-Ebadi
, K. Mostaguir
, M. M. Hovens
, M. Kare
, F. Verschuren
, P. Girard
, M. V. Huisman
, F. Moustafa
, P. W. Kamphuisen
, H. R. Buller
, M. Righini
, G. Le Gal^*

^*Corresponding author for this work

Cardiovascular Centre (CVC)

Research output: Contribution to journal › Article › Academic › peer-review

27 Citations (Scopus)

79 Downloads (Pure)

Abstract

Background: Pretest probability assessment by a clinical prediction rule (CPR) is an important step in the management of patients with suspected pulmonary embolism (PE). A limitation to the use of CPRs is that their constitutive variables and corresponding number of points are difficult to memorize. A simplified version of the Geneva score (i.e. attributing one point to each variable) has been proposed but never been prospectively validated.

Aims: Prospective validation of the simplified Geneva score (SGS) and comparison with the previous version of the Geneva score (GS).

Methods: In the ADJUST-PE study, which had the primary aim of validating the age-adjusted D-dimer cut-off, the SGS was prospectively used to determine the pretest probability in a subsample of 1621 study patients.

Results: Overall, PE was confirmed in 294 (18.1%) patients. Using the SGS, 608 (37.5%), 980 (60.5%) and 33 (2%) were classified as having a low, intermediate and high clinical probability. Corresponding prevalences of PE were 9.7%, 22.4% and 45.5%; 490 (30.1%) patients with low or intermediate probability had a D-dimer level below 500gL(-1) and 653 (41.1%) had a negative D-dimer test according to the age-adjusted cut-off. Using the GS, the figures were 491(30.9%) and 650 (40.9%). None of the patients considered as not having PE based on a low or intermediate SGS and negative D-dimer had a recurrent thromboembolic event during the 3-month follow-up.

Conclusions: The use of SGS has similar efficiency and safety to the GS in excluding PE in association with the D-dimer test.

Original language	English
Pages (from-to)	1764-1769
Number of pages	6
Journal	Journal of Thrombosis and Haemostasis
Volume	15
Issue number	9
DOIs	https://doi.org/10.1111/jth.13770
Publication status	Published - Sept-2017

Keywords

age-adjusted D-dimer cut-off
clinical prediction rules
diagnosis
diagnostic tests
pulmonary embolism
D-DIMER
PREDICTION RULES
DECISION RULES
MANAGEMENT
DIAGNOSIS
EMERGENCY
MODEL
METAANALYSIS
TRIAL

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Robert-Ebadi_et_al-2017-Journal_of_Thrombosis_and_HaemostasisFinal publisher's version, 110 KBLicence: Taverne

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Robert-Ebadi, H., Mostaguir, K., Hovens, M. M., Kare, M., Verschuren, F., Girard, P., Huisman, M. V., Moustafa, F., Kamphuisen, P. W., Buller, H. R., Righini, M., & Le Gal, G. (2017). Assessing clinical probability of pulmonary embolism: Prospective validation of the simplified Geneva score. Journal of Thrombosis and Haemostasis, 15(9), 1764-1769. https://doi.org/10.1111/jth.13770

@article{1349c25e3d6d4a4c8280e5286b5c0af4,

title = "Assessing clinical probability of pulmonary embolism: Prospective validation of the simplified Geneva score",

abstract = "Background: Pretest probability assessment by a clinical prediction rule (CPR) is an important step in the management of patients with suspected pulmonary embolism (PE). A limitation to the use of CPRs is that their constitutive variables and corresponding number of points are difficult to memorize. A simplified version of the Geneva score (i.e. attributing one point to each variable) has been proposed but never been prospectively validated.Aims: Prospective validation of the simplified Geneva score (SGS) and comparison with the previous version of the Geneva score (GS).Methods: In the ADJUST-PE study, which had the primary aim of validating the age-adjusted D-dimer cut-off, the SGS was prospectively used to determine the pretest probability in a subsample of 1621 study patients.Results: Overall, PE was confirmed in 294 (18.1\%) patients. Using the SGS, 608 (37.5\%), 980 (60.5\%) and 33 (2\%) were classified as having a low, intermediate and high clinical probability. Corresponding prevalences of PE were 9.7\%, 22.4\% and 45.5\%; 490 (30.1\%) patients with low or intermediate probability had a D-dimer level below 500gL(-1) and 653 (41.1\%) had a negative D-dimer test according to the age-adjusted cut-off. Using the GS, the figures were 491(30.9\%) and 650 (40.9\%). None of the patients considered as not having PE based on a low or intermediate SGS and negative D-dimer had a recurrent thromboembolic event during the 3-month follow-up.Conclusions: The use of SGS has similar efficiency and safety to the GS in excluding PE in association with the D-dimer test.",

keywords = "age-adjusted D-dimer cut-off, clinical prediction rules, diagnosis, diagnostic tests, pulmonary embolism, D-DIMER, PREDICTION RULES, DECISION RULES, MANAGEMENT, DIAGNOSIS, EMERGENCY, MODEL, METAANALYSIS, TRIAL",

author = "H. Robert-Ebadi and K. Mostaguir and Hovens, \{M. M.\} and M. Kare and F. Verschuren and P. Girard and Huisman, \{M. V.\} and F. Moustafa and Kamphuisen, \{P. W.\} and Buller, \{H. R.\} and M. Righini and \{Le Gal\}, G.",

year = "2017",

month = sep,

doi = "10.1111/jth.13770",

language = "English",

volume = "15",

pages = "1764--1769",

journal = "Journal of Thrombosis and Haemostasis",

issn = "1538-7933",

publisher = "Wiley",

number = "9",

}

Robert-Ebadi, H, Mostaguir, K, Hovens, MM, Kare, M, Verschuren, F, Girard, P, Huisman, MV, Moustafa, F, Kamphuisen, PW, Buller, HR, Righini, M & Le Gal, G 2017, 'Assessing clinical probability of pulmonary embolism: Prospective validation of the simplified Geneva score', Journal of Thrombosis and Haemostasis, vol. 15, no. 9, pp. 1764-1769. https://doi.org/10.1111/jth.13770

TY - JOUR

T1 - Assessing clinical probability of pulmonary embolism

T2 - Prospective validation of the simplified Geneva score

AU - Robert-Ebadi, H.

AU - Mostaguir, K.

AU - Hovens, M. M.

AU - Kare, M.

AU - Verschuren, F.

AU - Girard, P.

AU - Huisman, M. V.

AU - Moustafa, F.

AU - Kamphuisen, P. W.

AU - Buller, H. R.

AU - Righini, M.

AU - Le Gal, G.

PY - 2017/9

Y1 - 2017/9

N2 - Background: Pretest probability assessment by a clinical prediction rule (CPR) is an important step in the management of patients with suspected pulmonary embolism (PE). A limitation to the use of CPRs is that their constitutive variables and corresponding number of points are difficult to memorize. A simplified version of the Geneva score (i.e. attributing one point to each variable) has been proposed but never been prospectively validated.Aims: Prospective validation of the simplified Geneva score (SGS) and comparison with the previous version of the Geneva score (GS).Methods: In the ADJUST-PE study, which had the primary aim of validating the age-adjusted D-dimer cut-off, the SGS was prospectively used to determine the pretest probability in a subsample of 1621 study patients.Results: Overall, PE was confirmed in 294 (18.1%) patients. Using the SGS, 608 (37.5%), 980 (60.5%) and 33 (2%) were classified as having a low, intermediate and high clinical probability. Corresponding prevalences of PE were 9.7%, 22.4% and 45.5%; 490 (30.1%) patients with low or intermediate probability had a D-dimer level below 500gL(-1) and 653 (41.1%) had a negative D-dimer test according to the age-adjusted cut-off. Using the GS, the figures were 491(30.9%) and 650 (40.9%). None of the patients considered as not having PE based on a low or intermediate SGS and negative D-dimer had a recurrent thromboembolic event during the 3-month follow-up.Conclusions: The use of SGS has similar efficiency and safety to the GS in excluding PE in association with the D-dimer test.

AB - Background: Pretest probability assessment by a clinical prediction rule (CPR) is an important step in the management of patients with suspected pulmonary embolism (PE). A limitation to the use of CPRs is that their constitutive variables and corresponding number of points are difficult to memorize. A simplified version of the Geneva score (i.e. attributing one point to each variable) has been proposed but never been prospectively validated.Aims: Prospective validation of the simplified Geneva score (SGS) and comparison with the previous version of the Geneva score (GS).Methods: In the ADJUST-PE study, which had the primary aim of validating the age-adjusted D-dimer cut-off, the SGS was prospectively used to determine the pretest probability in a subsample of 1621 study patients.Results: Overall, PE was confirmed in 294 (18.1%) patients. Using the SGS, 608 (37.5%), 980 (60.5%) and 33 (2%) were classified as having a low, intermediate and high clinical probability. Corresponding prevalences of PE were 9.7%, 22.4% and 45.5%; 490 (30.1%) patients with low or intermediate probability had a D-dimer level below 500gL(-1) and 653 (41.1%) had a negative D-dimer test according to the age-adjusted cut-off. Using the GS, the figures were 491(30.9%) and 650 (40.9%). None of the patients considered as not having PE based on a low or intermediate SGS and negative D-dimer had a recurrent thromboembolic event during the 3-month follow-up.Conclusions: The use of SGS has similar efficiency and safety to the GS in excluding PE in association with the D-dimer test.

KW - age-adjusted D-dimer cut-off

KW - clinical prediction rules

KW - diagnosis

KW - diagnostic tests

KW - pulmonary embolism

KW - D-DIMER

KW - PREDICTION RULES

KW - DECISION RULES

KW - MANAGEMENT

KW - DIAGNOSIS

KW - EMERGENCY

KW - MODEL

KW - METAANALYSIS

KW - TRIAL

U2 - 10.1111/jth.13770

DO - 10.1111/jth.13770

M3 - Article

SN - 1538-7933

VL - 15

SP - 1764

EP - 1769

JO - Journal of Thrombosis and Haemostasis

JF - Journal of Thrombosis and Haemostasis

IS - 9

ER -

Assessing clinical probability of pulmonary embolism: Prospective validation of the simplified Geneva score

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Keywords

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