Aurelija Daškevičiūtė, Aurelija Navickaitė, Rokas Šerpytis, Pranas Šerpytis
Introduction. Diagnostics of acute pulmonary embolism (PE) in elderly patients may be difficult because of the coexistent cardiopulmonary conditions and age unfavorable influence on the characteristics of diagnostic tests for PE. Aim of the study. To compare the diagnostic values of the Wells score, the revised Geneva score and each of them combined with D-dimer for suspected PE in elderly patients. Methods. A retrospective analysis of 516 patients admitted to Vilnius University hospital Santara clinics Emergency department with suspected PE from January 2013 to January 2014 was conducted. Patients were divided into two groups according to their age admitted: ≥ 65 and < 65 years old. The positive predictive values of the Wells and revised Geneva scores as well as the negative predictive values of D-dimer, the Wells score combined with D-dimer and the revised Geneva score combined with D-dimer were calculated. Results. Out of 516 cases, 219 (42.4%) were diagnosed with PE based on computed tomography angiography. Among PE patients 150 (45.5%) were ≥ 65 years old. The positive predictive values of Wells and revised Geneva scores were 74.3% (95% CI: 65.06 – 82.20) and 49.6% (95% CI: 43.49 – 55.77) in the elderly patients (p < 0.001). The negative predictive value of D-dimer was 95.74% (95% CI: 85.46 – 99.48), the negative predictive values of the Wells score combined with D-dimer and the revised Geneva score combined with D-dimer were 100.00% (95% CI: 84.56 – 100.00) and 100.00% (95% CI: 59.04 – 100.00) respectively in the elderly. Conclusions. The diagnostic value of the Wells score was higher than the revised Geneva score in the elderly patients with suspected PE. The combination of D-dimer concentration and either the Wells score or the revised Geneva score may be considered as a high value strategy to rule out PE.
Keyword(s): pulmonary embolism; Wells score; revised Geneva score; elderly.
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