Comparison of various clinical scoring systems in assessing the probability of pulmonary thromboembolism in adults in a Tertiary Care Hospital in South India

Abstract

Aim: The aim of the study was to compare various clinical scoring systems used in detecting pulmonary embolism (PE) in adults in Tertiary Care Hospital in South India. Materials and Methods: Prospective study was done in Apollo Hospital, Greams Road, Chennai, from January 2016 to December 2017. Sixty-five patients with suspected PE were included in the study. Details such as age, sex, pulse rate, and blood pressure were collected. Probability of PE was calculated with all four clinical scoring systems (Wells score, simplified Wells score, revised Geneva score, and simplified revised Geneva score) and compared with computed tomography–pulmonary angiography which was considered the gold standard. Results: This study included 65 patients with suspected PE. Among 65 patients, 39 (60%) were male and 26 (40%) were female. PE was present in 23 (35.4%) patients, of which 14 (60.9%) were male and 9 (39.1%) were female, but the difference was not statistically significant (P = 0.916). Wells score had a sensitivity of 87%, specificity of 67%, positive predictive value (PPV) of 59%, and negative predictive value of 90%. Simplified Wells score had a sensitivity of 91%, specificity of 50%, PPV of 50%, and negative predictive value of 91%. The revised Geneva score had a sensitivity of 70%, specificity of 52%, PPV of 44%, and negative predictive value of 76%. Simplified revised Geneva score had a sensitivity of 65%, specificity of 57%, PPV of 45%, and negative predictive value of 75%. Conclusion: From this study, we were able to infer that the simplified Wells score had high sensitivity and Wells score had high specificity in the diagnosis of PE. Simplified revised Geneva score had the least negative predictive value. It is very important to have a high index of suspicion for the diagnosis of PE and the clinical predictability scores are valuable tools in this regard.