Four different clinical decision rules in the diagnostic work-up of pe in patients with a malignancy

Objective: Pulmonary embolism (PE) frequently occurs in patients with malignancy, whereas the diagnostic yield of the clinical decision rule (CDR) and D-dimer test in the exclusion of PE is lower than in non-malignant patients. Four different CDRs, Wells score, Revised Geneva (RGS), Simplified Wells, and simplified RGS are used to exclude PE. In this study, we assessed which of these CDRs is associated with the highest exclusion rate in patients with a malignancy and suspected PE. Methods: Eight hundred and seven consecutive patients with suspected PE were included in the study of whom 114 had a malignancy. The proportion of patients who had an unlikely CDR and a negative D-dimer was calculated for all CDRs. VTE failure rate was assessed during 3-month follow-up. Results: In patients with malignancy 58% had an unlikely Wells score, which was higher compared to the other CDRs, without an increase in the failure rate. However, the addition of a normal D-dimer test greatly reduced the proportion of patients where PE could be excluded to a similar proportion as the other CDRs. (Table presented) Conclusion: In cancer patients with suspected PE, the convential Wells score gave the highest proportion of an 'unlikely' score. The number of patients where PE could be excluded was not different compared to the other CDRs because of the very low number of normal D-dimer tests.