Key result
Revised Geneva Score with age-adjusted D-dimer is associated with ~10% fewer CTPA scans in suspected PE.
Why the study?
To assess the percentage of CTPA procedures that could be avoided by methodical application of the Revised Geneva Score coupled with age-adjusted D-dimer cut-offs compared to clinical judgment alone in ED patients with suspected PE.
Does the methodical application of the Revised Geneva Score coupled with age-adjusted D-dimer cut-offs reduce avoidable CTPA procedures compared to clinical judgment alone in ED patients with suspected PE?
Observational (n=437)
No
Does the methodical application of the Revised Geneva Score coupled with age-adjusted D-dimer cut-offs reduce avoidable CTPA procedures compared to clinical judgment alone in ED patients with suspected PE?
Retrospective application of the Revised Geneva Score with age-adjusted D-dimer cut-offs suggests that nearly 10% of CTPA procedures for suspected PE could be safely avoided compared to clinical judgment alone.
PURPOSE: To assess the percentage of computed tomography pulmonary angiography (CTPA) procedures that could have been avoided by methodical application of the Revised Geneva Score (RGS) coupled with age-adjusted D-dimer cut-offs rather than only clinical judgment in Emergency Department patients with suspected pulmonary embolism (PE). MATERIAL AND METHODS: Between November 2019 and May 2020, 437 patients with suspected PE based on symptoms and D-dimer test were included in this study. All patients underwent to CTPA. For each patient, we retrospectively calculated the age-adjusted D-dimer cut-offs and the RGS in the original version. Finally, CT images were retrospectively reviewed, and the presence of PE was recorded. RESULTS: In total, 43 (9.84%) CTPA could have been avoided by use of RGS coupled with age-adjusted D-dimer cut-offs. Prevalence of PE was 14.87%. From the analysis of 43 inappropriate CTPA, 24 (55.81%) of patients did not show any thoracic signs, two (4.65%) of patients had PE, and the remaining patients had alternative thoracic findings. CONCLUSION: The study showed good prevalence of PE diagnoses in our department using only physician assessment, although 9.84% CTPA could have been avoided by methodical application of RGS coupled with age-adjusted D-dimer cut-offs.
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Mirabile et al. (2021) conducted an observational in Suspected pulmonary embolism (n=437). Revised Geneva Score coupled with age-adjusted D-dimer cut-offs vs. Physician assessment was evaluated on Avoidable CT pulmonary angiography procedures. Methodical application of the Revised Geneva Score coupled with age-adjusted D-dimer cut-offs could have avoided 9.84% of CT pulmonary angiography procedures in patients with suspected pulmonary embolism.
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