Key result
Combining age-adjusted D-dimer and revised Geneva score yields 100% NPV for predicting PE.
Why the study?
Pulmonary embolism diagnosis can be challenging due to nonspecific signs and symptoms, prompting evaluation of the validity of D-dimer combined with the revised Geneva score for PE prediction.
Does the combination of D-dimer testing and the revised Geneva score accurately predict pulmonary embolism in patients with suspected PE?
Observational (n=2,010)
No
Does the combination of D-dimer testing and the revised Geneva score accurately predict pulmonary embolism in patients with suspected PE?
p-value: p=<0.001
The combination of age-adjusted D-dimer and a revised Geneva score cutoff of <5 points can safely rule out pulmonary embolism in over half of suspected cases, potentially reducing unnecessary CTPA imaging.
D-dimer plus revised Geneva score may refine PE suspicion in retrospective cohorts; leaves open prospective validation before changing diagnostic pathways.
BACKGROUND: Pulmonary embolism (PE) diagnosis can sometimes be challenging due to the disease having nonspecific signs and symptoms at the time of presentation. The present study aimed to evaluate the validity of the D-dimer in combination with the revised Geneva score (RGS) in the prediction of pulmonary embolism. PATIENTS AND METHODS: This is a retrospective study of 2010 patients with suspected PE who had undergone both D-dimer testing followed by chest CT angiography (CTPA), irrespective of the D-dimer test results, at King Abdulaziz Medical City, Riyadh, Saudi Arabia, over 3 years, from Jan. 2016 to Jan. 2019. The predictive accuracy of D-dimer, adjusted D-dimer, and RGS was calculated. The receiver operating characteristic "ROC" curve was applied to allocate the optimum RGS cutoff for PE prediction. RESULTS: The overall prevalence of PE was 16%. It was 0%, 25.8%, and 88.9% in low, intermediate, and high clinical probability categories of RGS, respectively. Both conventional and age-adjusted D-dimer thresholds showed significant level of agreement (kappa=0.81, p<0.001), high sensitivity (94% and 92.8%), high negative predictive value "NPV" (91.2% and 91.4%), low specificity (12.3% and 15.3%), and low positive predictive value "PPV" (17.5% and 17.8%), respectively. Combination of the age-adjusted D-dimer threshold and RGS at a cut-off of 5 points would provide 100% sensitivity and 61.7% specificity 34.1% PPV, 100% NPV, and 0.87 area under the curve "AUC". At an RGS cutoff <5 points, PE could have been ruled out in more than one-half (1036, 51.5%) of all suspected cases, and would have saved the cost of CTPA. CONCLUSION: Conventional and age-adjusted D-dimer tests showed high levels of agreement in the prediction of PE, high sensitivity, and low specificity. RGS has a good performance in PE prediction. Using the revised Geneva score alone rules out PE for more than one-half of all suspected without further imaging.
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Abolfotouh et al. (2020) conducted an observational in Pulmonary embolism (n=2,010). D-dimer testing and revised Geneva score vs. Chest CT angiography was evaluated on Prediction of pulmonary embolism (p=<0.001). Combining the age-adjusted D-dimer threshold and revised Geneva score at a cut-off of 5 points provided 100% sensitivity, 100% NPV, and an AUC of 0.87 for predicting pulmonary embolism.
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