Key result
In patients undergoing CT pulmonary angiography for suspected pulmonary embolism, the Revised Geneva Score was a significant predictor of PE (OR 1.27 per point), but its overall diagnostic usefulness in this pre-selected population was relatively low (AUC 0.64).
Why the study?
The study was conducted to evaluate the utility of the revised Geneva score and other clinical and laboratory predictors of pulmonary embolism on CT pulmonary angiography.
Does the Revised Geneva Score predict the presence of pulmonary embolism on CT pulmonary angiogram in patients with suspected pulmonary embolism?
Observational (n=581)
No
Does the Revised Geneva Score predict the presence of pulmonary embolism on CT pulmonary angiogram in patients with suspected pulmonary embolism?
The Revised Geneva Score has low diagnostic utility (AUC 0.64) in patients who have already been selected to undergo CT pulmonary angiography, and cannot replace imaging even when combined with D-dimer levels.
Answers are grounded in this paper and cite their sources.
RGS shows limited utility for predicting PE on CTPA in this cohort; leaves open whether refined scores can safely reduce imaging.
CĂŽl: AnalĂ˝za dat ze souboru nemocnĂ˝ch vyĹĄetĹenĂ˝ch pro klinickĂŠ podezĹenĂ na plicnĂ embolii (PE) pomocĂ CT angiografie plicnice (CTPA) v Nemocnici TĂĄbor za jeden rok od bĹezna 2019 do Ăşnora 2020. ZhodnocenĂ uĹžiteÄnosti revidovanĂŠho ĹženevskĂŠho skĂłre (RGS) v tomto souboru. Metodika: RetrospektivnĂ analĂ˝za souboru dat vĹĄech pacientĹŻ, u nichĹž byla v obdobĂ od bĹezna 2019 do Ăşnora 2020 na RadiologickĂŠm oddÄlenĂ Nemocnice TĂĄbor provedena CTPA pro klinickĂŠ podezĹenĂ na PE. Byla vypoÄtena hodnota RGS a byla srovnĂĄna se znĂĄmĂ˝mi vĂ˝sledky CTPA. DĂĄle byly analyzovĂĄny dalĹĄĂ klinickĂŠ a laboratornĂ parametry a jejich uĹžiteÄnost v predikci vĂ˝skytu plicnĂ embolie na CTPA. VĂ˝sledky: Celkem bylo do souboru zaĹazeno 584 konsekutivnĂch pacientĹŻ, z nichĹž 3 byli vyĹazeni pro chybÄjĂcĂ Ăşdaje. PE byla zjiĹĄtÄna u 132 (22,60 %) pacientĹŻ (71 muŞů, 53,8 %); odpovĂdĂĄ pĹi poÄtu obyvatel 102 451 v roce 20191 incidenci necelĂ˝ch 129/100 000. NĂzkĂĄ pravdÄpodobnost pĹĂtomnosti PE dle RGS byla vypoÄtena u 37,2 % pacientĹŻ, stĹednĂ u 62,5 %, vysokĂĄ u 0,3 % nemocnĂ˝ch. NejÄastÄjĹĄĂm symptomem, pro kterĂ˝ pacient vyhledal lĂŠkaĹskou pomoc, byla duĹĄnost (342; 58 %). RGS dosahovalo v tomto souboru plochy pod kĹivkou (AUC) 0,64. V multivariaÄnĂ analĂ˝ze byly prediktory vĂ˝skytu plicnĂ embolie na CTPA v danĂŠm souboru hodnota ĹženevskĂŠho skĂłre (pomÄr ĹĄancĂ [OR] 1,27 za bod, p < 0,001) a D-dimerĹŻ (OR 1,19 za µg/l, p < 0,001), dĂĄle muĹžskĂŠ pohlavĂ (OR 1,99, p = 0,031) a jako negativnĂ prediktor ischemickĂŠ choroby srdeÄnĂ (ICHS) v anamnĂŠze (OR 0,31, p = 0,027). Ani kombinovanĂ˝ model vytvoĹenĂ˝ z klinickĂ˝ch a paraklinickĂ˝ch promÄnnĂ˝ch nestaÄĂ, aby nahradil provedenĂ CTPA (AUC 0,78). ZĂĄvÄr: Incidence PE v naĹĄem souboru je na hornĂ hranici bÄĹžnÄ udĂĄvanĂŠ a souÄasnÄ potvrzuje trend narĹŻstajĂcĂ incidence PE v Äase. UĹžiteÄnost RGS v populaci, kde je jiĹž rozhodnuto provĂŠst CTPA, je pomÄrnÄ nĂzkĂĄ a ani spoleÄnÄ s hodnotou D-dimerĹŻ nestaÄĂ k nahrazenĂ CTPA.
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Adámek et al. (2024) conducted an observational in Suspected pulmonary embolism (n=581). Revised Geneva Score (RGS) was evaluated on Diagnosis of pulmonary embolism on CT pulmonary angiogram (OR 1.27, 95% CI 1.16-1.39, p=<0.001). In patients undergoing CT pulmonary angiography for suspected pulmonary embolism, the Revised Geneva Score was a significant predictor of PE (OR 1.27 per point), but its overall diagnostic usefulness in this pre-selected population was relatively low (AUC 0.64).
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