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Menno V Huisman - One of the best experts on this subject based on the ideXlab platform.
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assessing clinical probability of pulmonary embolism prospective validation of the simplified Geneva Score
Journal of Thrombosis and Haemostasis, 2017Co-Authors: Helia Robertebadi, Menno V Huisman, Khaled Mostaguir, Marcel M C Hovens, M Kare, F Verschuren, Philippe Girard, Fares Moustafa, Pieter W Kamphuisen, H R BullerAbstract:Essentials The simplified Geneva Score allows easier pretest probability assessment of pulmonary embolism (PE). We prospectively validated this Score in the ADJUST-PE management outcome study. The study shows that it is safe to manage patients with suspected PE according to this Score. The simplified Geneva Score is now ready for use in routine clinical practice. SummaryBackground Pretest probability assessment by a clinical prediction rule (CPR) is an important step in the management of patients with suspected pulmonary embolism (PE). A limitation to the use of CPRs is that their constitutive variables and corresponding number of points are difficult to memorize. A simplified version of the Geneva Score (i.e. attributing one point to each variable) has been proposed but never been prospectively validated. Aims Prospective validation of the simplified Geneva Score (SGS) and comparison with the previous version of the Geneva Score (GS). Methods In the ADJUST-PE study, which had the primary aim of validating the age-adjusted D-dimer cut-off, the SGS was prospectively used to determine the pretest probability in a subsample of 1621 study patients. Results Overall, PE was confirmed in 294 (18.1%) patients. Using the SGS, 608 (37.5%), 980 (60.5%) and 33 (2%) were classified as having a low, intermediate and high clinical probability. Corresponding prevalences of PE were 9.7%, 22.4% and 45.5%; 490 (30.1%) patients with low or intermediate probability had a D-dimer level below 500 μg L−1 and 653 (41.1%) had a negative D-dimer test according to the age-adjusted cut-off. Using the GS, the figures were 491(30.9%) and 650 (40.9%). None of the patients considered as not having PE based on a low or intermediate SGS and negative D-dimer had a recurrent thromboembolic event during the 3-month follow-up. Conclusions The use of SGS has similar efficiency and safety to the GS in excluding PE in association with the D-dimer test.
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assessing clinical probability of pulmonary embolism prospective validation of the simplified Geneva Score in outpatients
Journal of Thrombosis and Haemostasis, 2017Co-Authors: Helia Robertebadi, Menno V Huisman, Khaled Mostaguir, Marcel M C Hovens, M Kare, F Verschuren, Philippe Girard, Fares Moustafa, Pieter W Kamphuisen, H R BullerAbstract:Abstract Pretest probability assessment by a clinical prediction rule (CPR) is an important step in the management of patients with suspected pulmonary embolism (PE). A limitation to the use of CPR is that their constitutive variables and corresponding number of points are difficult to memorize. A simplified version of the Geneva Score (i.e. attributing one point to each variable) has been proposed but never been prospectively validated. Prospective validation of the simplified Geneva Score (SGS) and comparison with the previous version of the Geneva Score (GS). In the ADJUST-PE study, whose primary aim was to validate the age-adjusted D-dimer cut-off, the SGS was prospectively used to determine the pretest probability in a subsample of 1,621 study patients. Overall, PE was confirmed in 294 (18.1%) patients. Using the SGS, 608 (37.5%), 980 (60.5%), and 33 (2%) were classified as having a low, intermediate and high clinical probability. Corresponding PE prevalences were 9.7%, 22.4% and 45.5%; 490 (30.1%) of patients with low or intermediate probability had a D-dimer level below 500 μg/L and 653 (41.1%) had a negative D-dimer test according to the age-adjusted cut-off. Using the GS, the figures were: 491(30.9%) and 650 (40.9%). None of the patients considered as not having PE based on a low or intermediate SGS and negative D-dimer had a recurrent thromboembolic event during the 3-month follow-up. The use of SGS results in a similar yield and safety than the GS to exclude PE in association with the D-dimer test. This article is protected by copyright. All rights reserved.
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performance of the revised Geneva Score in patients with a delayed suspicion of pulmonary embolism
European Respiratory Journal, 2014Co-Authors: Paul Den L Exter, Inge C M Mos, Menno V Huisman, Pim Van Den Hoven, Tom Van Der Hulle, Renee A Douma, Josien Van Es, Frederikus A KlokAbstract:To the Editor: Establishing a prompt diagnosis of acute pulmonary embolism is a diagnostic challenge, as the clinical presentation ranges from haemodynamic shock to very subtle symptoms mimicking those of other cardiovascular or pulmonary diseases [1]. This diverse presentation facilitates diagnostic delay and, consequently, also a delay in treatment initiation, which might be an important prognostic indicator for patients with acute pulmonary embolism [1]. The standard diagnostic algorithm for suspected acute pulmonary embolism consists of sequential pre-test probability determination, D-dimer testing and computed tomography pulmonary angiography (CTPA) [2]. The pre-test probability can be estimated using a validated clinical decision rule (CDR), such as the Wells Score and the revised Geneva Score (RGS) [3, 4]. In addition to an excellent sensitivity and specificity, the main advantage of this diagnostic algorithm is that 20–30% of all patients with a clinical suspicion can be managed without CTPA, since an unlikely clinical probability in combination with a normal high-sensitive D-dimer test result has been shown to accurately rule out acute symptomatic pulmonary embolism [5]. The significance of the appropriate use of this diagnostic management strategy in patients with suspected pulmonary embolism has been highlighted by a prospective cohort study [6]. In patients with inappropriate diagnostic management, the diagnostic failure rate was 7.7%, compared to 1.2% for those patients in whom pulmonary embolism was ruled out according to the strategy (p<0.001). Importantly, symptoms suggestive of pulmonary embolism that could also be ascribed to underlying cardiopulmonary diseases ( e.g. heart failure or chronic lung disease) were identified as an important factor …
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Simplification of the revised Geneva Score for assessing clinical probability of pulmonary embolism.
Archives of Internal Medicine -New Series-, 2008Co-Authors: Frederikus A Klok, Inge C M Mos, Mathilde Nijkeuter, Marc Righini, Arnaud Perrier, Grégoire Le Gal, Menno V HuismanAbstract:BACKGROUND: The revised Geneva Score is a fully standardized clinical decision rule (CDR) in the diagnostic workup of patients with suspected pulmonary embolism (PE). The variables of the decision rule have different weights, which could lead to miscalculations in an acute setting. We have validated a simplified version of the revised Geneva Score. METHODS: Data from 1049 patients from 2 large prospective diagnostic trials that included patients with suspected PE were used and combined to validate the simplified revised Geneva Score. We constructed the simplified CDR by attributing 1 point to each item of the original CDR and compared the diagnostic accuracy of the 2 versions by a receiver operating characteristic curve analysis. We also assessed the clinical utility of the simplified CDR by evaluating the safety of ruling out PE on the basis of the combination of either a low-intermediate clinical probability (using a 3-level scheme) or a "PE unlikely" assessment (using a dichotomized rule) with a normal result on a highly sensitive D-dimer test. RESULTS: The complete study population had an overall prevalence of venous thromboembolism of 23%. The diagnostic accuracy between the 2 CDRs did not differ (area under the curve for the revised Geneva Score was 0.75 [95% confidence interval, 0.71-0.78] vs 0.74 [0.70-0.77] for the simplified revised Geneva Score). During 3 months of follow-up, no patient with a combination of either a low (0%; 95% confidence interval, 0.0%-1.7%) or intermediate (0%; 0.0%-2.8%) clinical probability, or a "PE unlikely" assessment (0%; 0.0%-1.2%) with the simplified Score and a normal result of a D-dimer test was diagnosed as having venous thromboembolism. CONCLUSION: This study suggests that simplification of the revised Geneva Score does not lead to a decrease in diagnostic accuracy and clinical utility, which should be confirmed in a prospective study.
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Comparison of the revised Geneva Score with the Wells rule for assessing clinical probability of pulmonary embolism.
Journal of Thrombosis and Haemostasis, 2008Co-Authors: Frederikus A Klok, Mathilde Nijkeuter, Marc Righini, Arnaud Perrier, Grégoire Le Gal, E. Kruisman, J. Spaan, D. Aujesky, Pierre-marie Roy, Menno V HuismanAbstract:BACKGROUND: The revised Geneva Score, a standardized clinical decision rule in the diagnosis of pulmonary embolism (PE), was recently developed. The Wells clinical decision is widely used but lacks full standardization, as it includes subjective clinician's judgement. We have compared the performance of the revised Geneva Score with the Wells rule, and their usefulness for ruling out PE in combination with D-dimer measurement. METHODS: In 300 consecutive patients, the clinical probability of PE was assessed prospectively by the Wells rule and retrospectively using the revised Geneva Score. Patients comprised a random sample from a single center, participating in a large prospective multicenter diagnostic study. The predictive accuracy of both Scores was compared by area under the curve (AUC) of receiver operating characteristic (ROC) curves. RESULTS: The overall prevalence of PE was 16%. The prevalence of PE in the low-probability, intermediate-probability and high-probability categories as classified by the revised Geneva Score was similar to that of the original derivation set. The performance of the revised Geneva Score as measured by the AUC in a ROC analysis did not differ statistically from the Wells rule. After 3 months of follow-up, no patient classified into the low or intermediate clinical probability category by the revised Geneva Score and a normal D-dimer result was subsequently diagnosed with acute venous thromboembolism. CONCLUSIONS: This study suggests that the performance of the revised Geneva Score is equivalent to that of the Wells rule. In addition, it seems safe to exclude PE in patients by the combination of a low or intermediate clinical probability by the revised Geneva Score and a normal D-dimer level. Prospective clinical outcome studies are needed to confirm this latter finding.
Andrea Penaloza - One of the best experts on this subject based on the ideXlab platform.
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comparison of the wells Score and the revised Geneva Score as a tool to predict pulmonary embolism in outpatients over age 65
Thrombosis Research, 2020Co-Authors: Julien Coelho, Pierre-marie Roy, Andrea Penaloza, Margaux Divernetqueriaud, Gregoire Le Gal, A TrinhducAbstract:Abstract Title Comparison of the Wells Score and the revised Geneva Score as a tool to predict pulmonary embolism in outpatients over 65 years of age. Introduction The incidence and mortality of pulmonary embolism (PE) is high in the elderly. The Wells Score (SW) and the revised Geneva Score (RGS) have been validated in patient populations with a large age range. The aim of this study was to compare the predictive accuracy of these two Scores in diagnosis of PE in patients over 65 years of age. Method A prospective multicentre study (nine French and three Belgian centres) was conducted at the same time as the PERCEPIC study. A total of 1757 patients admitted with suspected PE were included and divided into two groups according to age (≥65 years or Results The overall prevalence of PE was 11.3%. The prevalence among patients aged ≥65 in the low, moderate and high pre-test probability groups, evaluated using the WS and was respectively 13.5% (CI 95%: CI 9.9–17.3), 28.2% (CI 22.1–34.3), 50% (CI 26–74) and 8.1% (CI 3.2–12.9), 22.3% (CI 18.2–26.3), 43.7% (CI 25.6–61.9) using the RGS. The AUC for the WS and RGS for patients aged ≥65 was 0.632 (CI 0.574–0.691) and 0.610 (CI 0.555–0.666). The difference between the AUCs was not statistically significant (p = .441). Conclusion In the population for this study, the WS and RGS have the same PE diagnostic accuracy in patients over age 65. This result should be validated in a prospective study that directly compares these Scores.
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comparison of the unstructured clinician gestalt the wells Score and the revised Geneva Score to estimate pretest probability for suspected pulmonary embolism
Annals of Emergency Medicine, 2013Co-Authors: Andrea Penaloza, Franck Verschuren, Guy Meyer, Sybille Quentingeorget, Caroline Soulie, Frederic Thys, Pierre-marie RoyAbstract:Study objective: The assessment of clinical probability (as low, moderate, or high) with clinical decision rules has become a cornerstone of diagnostic strategy for patients with suspected pulmonary embolism, but little is known about the use of physician gestalt assessment of clinical probability. We evaluate the performance of gestalt assessment for diagnosing pulmonary embolism. Methods: We conducted a retrospective analysis of a prospective observational cohort of consecutive suspected pulmonary embolism patients in emergency departments. Accuracy of gestalt assessment was compared with the Wells Score and the revised Geneva Score by the area under the curve (AUC) of receiver operating characteristic curves. Agreement between the 3 methods was determined by κ test. Results: The study population was 1,038 patients, with a pulmonary embolism prevalence of 31.3%. AUC differed significantly between the 3 methods and was 0.81 (95% confidence interval [CI] 0.78 to 0.84) for gestalt assessment, 0.71 (95% CI 0.68 to 0.75) for Wells, and 0.66 (95% CI 0.63 to 0.70) for the revised Geneva Score. The proportion of patients categorized as having low clinical probability was statistically higher with gestalt than with revised Geneva Score (43% versus 26%; 95% CI for the difference of 17%=13% to 21%). Proportion of patients categorized as having high clinical probability was higher with gestalt than with Wells (24% versus 7%; 95% CI for the difference of 17%=14% to 20%) or revised Geneva Score (24% versus 10%; 95% CI for the difference of 15%=13% to 21%). Pulmonary embolism prevalence was significantly lower with gestalt versus clinical decision rules in low clinical probability (7.6% for gestalt versus 13.0% for revised Geneva Score and 12.6% for Wells Score) and non-high clinical probability groups (18.3% for gestalt versus 29.3% for Wells and 27.4% for revised Geneva Score) and was significantly higher with gestalt versus Wells Score in high clinical probability groups (72.1% versus 58.1%). Agreement between the 3 methods was poor, with all κ values below 0.3. Conclusion: In our retrospective study, gestalt assessment seems to perform better than clinical decision rules because of better selection of patients with low and high clinical probability.
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comparison of the wells Score with the simplified revised Geneva Score for assessing pretest probability of pulmonary embolism
Thrombosis Research, 2011Co-Authors: Andrea Penaloza, Christian Melot, Serge MotteAbstract:INTRODUCTION: The Wells Score is widely used in the assessment of pretest probability of pulmonary embolism (PE). The revised Geneva Score is a fully standardized clinical decision rule that was recently validated and further simplified. We compared the predictive accuracy of these two Scores. METHODS: Data from 339 patients clinically suspected of PE from two prospective management studies were used and combined. Pretest probability of PE was assessed prospectively by the Wells Score. The simplified revised (SR) Geneva Score was calculated retrospectively. The predictive accuracy of both Scores was compared by area under the curve (AUC) of receiver operating characteristic (ROC) curves. RESULTS: The overall prevalence of PE was 19%. Prevalence of PE in the low, moderate and high pretest probability groups assessed by the Wells Score and by the simplified revised Geneva Score was respectively 2%(95% CI (CI) 1-6) and 4% (CI 2-10), 28% (CI 22-35) and 25% (CI 20-32), 93% (CI 70-99) and 56% (CI 27-81). The Wells Score performed better than the simplified revised Geneva Score in patients with a high suspicion of PE (p<0.05). The AUC for the Wells Score and the simplified revised Geneva Score was 0.85 (CI: 0.81 to 0.89) and 0.76 (CI: 0.71 to 0.80) respectively. The difference between the AUCs was statistically significant (p=0.005). CONCLUSIONS: In our population the Wells Score appeared to be more accurate than the simplified revised Geneva Score. The impact of this finding in terms of patient outcomes should be investigated in a prospective study.
H R Buller - One of the best experts on this subject based on the ideXlab platform.
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assessing clinical probability of pulmonary embolism prospective validation of the simplified Geneva Score
Journal of Thrombosis and Haemostasis, 2017Co-Authors: Helia Robertebadi, Menno V Huisman, Khaled Mostaguir, Marcel M C Hovens, M Kare, F Verschuren, Philippe Girard, Fares Moustafa, Pieter W Kamphuisen, H R BullerAbstract:Essentials The simplified Geneva Score allows easier pretest probability assessment of pulmonary embolism (PE). We prospectively validated this Score in the ADJUST-PE management outcome study. The study shows that it is safe to manage patients with suspected PE according to this Score. The simplified Geneva Score is now ready for use in routine clinical practice. SummaryBackground Pretest probability assessment by a clinical prediction rule (CPR) is an important step in the management of patients with suspected pulmonary embolism (PE). A limitation to the use of CPRs is that their constitutive variables and corresponding number of points are difficult to memorize. A simplified version of the Geneva Score (i.e. attributing one point to each variable) has been proposed but never been prospectively validated. Aims Prospective validation of the simplified Geneva Score (SGS) and comparison with the previous version of the Geneva Score (GS). Methods In the ADJUST-PE study, which had the primary aim of validating the age-adjusted D-dimer cut-off, the SGS was prospectively used to determine the pretest probability in a subsample of 1621 study patients. Results Overall, PE was confirmed in 294 (18.1%) patients. Using the SGS, 608 (37.5%), 980 (60.5%) and 33 (2%) were classified as having a low, intermediate and high clinical probability. Corresponding prevalences of PE were 9.7%, 22.4% and 45.5%; 490 (30.1%) patients with low or intermediate probability had a D-dimer level below 500 μg L−1 and 653 (41.1%) had a negative D-dimer test according to the age-adjusted cut-off. Using the GS, the figures were 491(30.9%) and 650 (40.9%). None of the patients considered as not having PE based on a low or intermediate SGS and negative D-dimer had a recurrent thromboembolic event during the 3-month follow-up. Conclusions The use of SGS has similar efficiency and safety to the GS in excluding PE in association with the D-dimer test.
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assessing clinical probability of pulmonary embolism prospective validation of the simplified Geneva Score in outpatients
Journal of Thrombosis and Haemostasis, 2017Co-Authors: Helia Robertebadi, Menno V Huisman, Khaled Mostaguir, Marcel M C Hovens, M Kare, F Verschuren, Philippe Girard, Fares Moustafa, Pieter W Kamphuisen, H R BullerAbstract:Abstract Pretest probability assessment by a clinical prediction rule (CPR) is an important step in the management of patients with suspected pulmonary embolism (PE). A limitation to the use of CPR is that their constitutive variables and corresponding number of points are difficult to memorize. A simplified version of the Geneva Score (i.e. attributing one point to each variable) has been proposed but never been prospectively validated. Prospective validation of the simplified Geneva Score (SGS) and comparison with the previous version of the Geneva Score (GS). In the ADJUST-PE study, whose primary aim was to validate the age-adjusted D-dimer cut-off, the SGS was prospectively used to determine the pretest probability in a subsample of 1,621 study patients. Overall, PE was confirmed in 294 (18.1%) patients. Using the SGS, 608 (37.5%), 980 (60.5%), and 33 (2%) were classified as having a low, intermediate and high clinical probability. Corresponding PE prevalences were 9.7%, 22.4% and 45.5%; 490 (30.1%) of patients with low or intermediate probability had a D-dimer level below 500 μg/L and 653 (41.1%) had a negative D-dimer test according to the age-adjusted cut-off. Using the GS, the figures were: 491(30.9%) and 650 (40.9%). None of the patients considered as not having PE based on a low or intermediate SGS and negative D-dimer had a recurrent thromboembolic event during the 3-month follow-up. The use of SGS results in a similar yield and safety than the GS to exclude PE in association with the D-dimer test. This article is protected by copyright. All rights reserved.
Frederikus A Klok - One of the best experts on this subject based on the ideXlab platform.
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performance of the revised Geneva Score in patients with a delayed suspicion of pulmonary embolism
European Respiratory Journal, 2014Co-Authors: Paul Den L Exter, Inge C M Mos, Menno V Huisman, Pim Van Den Hoven, Tom Van Der Hulle, Renee A Douma, Josien Van Es, Frederikus A KlokAbstract:To the Editor: Establishing a prompt diagnosis of acute pulmonary embolism is a diagnostic challenge, as the clinical presentation ranges from haemodynamic shock to very subtle symptoms mimicking those of other cardiovascular or pulmonary diseases [1]. This diverse presentation facilitates diagnostic delay and, consequently, also a delay in treatment initiation, which might be an important prognostic indicator for patients with acute pulmonary embolism [1]. The standard diagnostic algorithm for suspected acute pulmonary embolism consists of sequential pre-test probability determination, D-dimer testing and computed tomography pulmonary angiography (CTPA) [2]. The pre-test probability can be estimated using a validated clinical decision rule (CDR), such as the Wells Score and the revised Geneva Score (RGS) [3, 4]. In addition to an excellent sensitivity and specificity, the main advantage of this diagnostic algorithm is that 20–30% of all patients with a clinical suspicion can be managed without CTPA, since an unlikely clinical probability in combination with a normal high-sensitive D-dimer test result has been shown to accurately rule out acute symptomatic pulmonary embolism [5]. The significance of the appropriate use of this diagnostic management strategy in patients with suspected pulmonary embolism has been highlighted by a prospective cohort study [6]. In patients with inappropriate diagnostic management, the diagnostic failure rate was 7.7%, compared to 1.2% for those patients in whom pulmonary embolism was ruled out according to the strategy (p<0.001). Importantly, symptoms suggestive of pulmonary embolism that could also be ascribed to underlying cardiopulmonary diseases ( e.g. heart failure or chronic lung disease) were identified as an important factor …
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performance of 4 clinical decision rules in the diagnostic management of acute pulmonary embolism a prospective cohort study
Annals of Internal Medicine, 2011Co-Authors: Renee A Douma, Frederikus A Klok, Marcel M C Hovens, I C M Mos, Petra M G Erkens, T A C Nizet, Marc F Durian, Anja A Van Houten, H M A Hofstee, Hugo Ten CateAbstract:Background: Several clinical decision rules (CDRs) are available to exclude acute pulmonary embolism (PE), but they have not been directly compared. Objective: To directly compare the performance of 4 CDRs (Wells rule, revised Geneva Score, simplified Wells rule, and simplified revised Geneva Score) in combination with D-dimer testing to exclude PE. Design: Prospective cohort study. Setting: 7 hospitals in the Netherlands. Patients: 807 consecutive patients with suspected acute PE. Intervention: The clinical probability of PE was assessed by using a computer program that calculated all CDRs and indicated the next diagnostic step. Results of the CDRs and D-dimer tests guided clinical care. Measurements: Results of the CDRs were compared with the prevalence of PE identified by computed tomography or venous thromboembolism at 3-month follow-up. Results: Prevalence of PE was 23%. The proportion of patients categorized as PE-unlikely ranged from 62% (simplified Wells rule) to 72% (Wells rule). Combined with a normal D-dimer result, the CDRs excluded PE in 22% to 24% of patients. The total failure rates of the CDR and D-dimer combinations were similar (1 failure, 0.5% to 0.6% [upper-limit 95% CI, 2.9% to 3.1%]). Even though 30% of patients had discordant CDR outcomes, PE was not detected in any patient with discordant CDRs and a normal D-dimer result. Limitation: Management was based on a combination of decision rules and D-dimer testing rather than only 1 CDR combined with D-dimer testing. Conclusion: All 4 CDRs show similar performance for exclusion of acute PE in combination with a normal D-dimer result. This prospective validation indicates that the simplified Scores may be used in clinical practice. Primary Funding Source: Academic Medical Center, VU University Medical Center, Rijnstate Hospital, Leiden University Medical Center, Maastricht University Medical Center, Erasmus Medical Center, and Maasstad Hospital. © 2011 American College of Physicians.
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Simplification of the revised Geneva Score for assessing clinical probability of pulmonary embolism.
Archives of Internal Medicine -New Series-, 2008Co-Authors: Frederikus A Klok, Inge C M Mos, Mathilde Nijkeuter, Marc Righini, Arnaud Perrier, Grégoire Le Gal, Menno V HuismanAbstract:BACKGROUND: The revised Geneva Score is a fully standardized clinical decision rule (CDR) in the diagnostic workup of patients with suspected pulmonary embolism (PE). The variables of the decision rule have different weights, which could lead to miscalculations in an acute setting. We have validated a simplified version of the revised Geneva Score. METHODS: Data from 1049 patients from 2 large prospective diagnostic trials that included patients with suspected PE were used and combined to validate the simplified revised Geneva Score. We constructed the simplified CDR by attributing 1 point to each item of the original CDR and compared the diagnostic accuracy of the 2 versions by a receiver operating characteristic curve analysis. We also assessed the clinical utility of the simplified CDR by evaluating the safety of ruling out PE on the basis of the combination of either a low-intermediate clinical probability (using a 3-level scheme) or a "PE unlikely" assessment (using a dichotomized rule) with a normal result on a highly sensitive D-dimer test. RESULTS: The complete study population had an overall prevalence of venous thromboembolism of 23%. The diagnostic accuracy between the 2 CDRs did not differ (area under the curve for the revised Geneva Score was 0.75 [95% confidence interval, 0.71-0.78] vs 0.74 [0.70-0.77] for the simplified revised Geneva Score). During 3 months of follow-up, no patient with a combination of either a low (0%; 95% confidence interval, 0.0%-1.7%) or intermediate (0%; 0.0%-2.8%) clinical probability, or a "PE unlikely" assessment (0%; 0.0%-1.2%) with the simplified Score and a normal result of a D-dimer test was diagnosed as having venous thromboembolism. CONCLUSION: This study suggests that simplification of the revised Geneva Score does not lead to a decrease in diagnostic accuracy and clinical utility, which should be confirmed in a prospective study.
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Comparison of the revised Geneva Score with the Wells rule for assessing clinical probability of pulmonary embolism.
Journal of Thrombosis and Haemostasis, 2008Co-Authors: Frederikus A Klok, Mathilde Nijkeuter, Marc Righini, Arnaud Perrier, Grégoire Le Gal, E. Kruisman, J. Spaan, D. Aujesky, Pierre-marie Roy, Menno V HuismanAbstract:BACKGROUND: The revised Geneva Score, a standardized clinical decision rule in the diagnosis of pulmonary embolism (PE), was recently developed. The Wells clinical decision is widely used but lacks full standardization, as it includes subjective clinician's judgement. We have compared the performance of the revised Geneva Score with the Wells rule, and their usefulness for ruling out PE in combination with D-dimer measurement. METHODS: In 300 consecutive patients, the clinical probability of PE was assessed prospectively by the Wells rule and retrospectively using the revised Geneva Score. Patients comprised a random sample from a single center, participating in a large prospective multicenter diagnostic study. The predictive accuracy of both Scores was compared by area under the curve (AUC) of receiver operating characteristic (ROC) curves. RESULTS: The overall prevalence of PE was 16%. The prevalence of PE in the low-probability, intermediate-probability and high-probability categories as classified by the revised Geneva Score was similar to that of the original derivation set. The performance of the revised Geneva Score as measured by the AUC in a ROC analysis did not differ statistically from the Wells rule. After 3 months of follow-up, no patient classified into the low or intermediate clinical probability category by the revised Geneva Score and a normal D-dimer result was subsequently diagnosed with acute venous thromboembolism. CONCLUSIONS: This study suggests that the performance of the revised Geneva Score is equivalent to that of the Wells rule. In addition, it seems safe to exclude PE in patients by the combination of a low or intermediate clinical probability by the revised Geneva Score and a normal D-dimer level. Prospective clinical outcome studies are needed to confirm this latter finding.
Pierre-marie Roy - One of the best experts on this subject based on the ideXlab platform.
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comparison of the wells Score and the revised Geneva Score as a tool to predict pulmonary embolism in outpatients over age 65
Thrombosis Research, 2020Co-Authors: Julien Coelho, Pierre-marie Roy, Andrea Penaloza, Margaux Divernetqueriaud, Gregoire Le Gal, A TrinhducAbstract:Abstract Title Comparison of the Wells Score and the revised Geneva Score as a tool to predict pulmonary embolism in outpatients over 65 years of age. Introduction The incidence and mortality of pulmonary embolism (PE) is high in the elderly. The Wells Score (SW) and the revised Geneva Score (RGS) have been validated in patient populations with a large age range. The aim of this study was to compare the predictive accuracy of these two Scores in diagnosis of PE in patients over 65 years of age. Method A prospective multicentre study (nine French and three Belgian centres) was conducted at the same time as the PERCEPIC study. A total of 1757 patients admitted with suspected PE were included and divided into two groups according to age (≥65 years or Results The overall prevalence of PE was 11.3%. The prevalence among patients aged ≥65 in the low, moderate and high pre-test probability groups, evaluated using the WS and was respectively 13.5% (CI 95%: CI 9.9–17.3), 28.2% (CI 22.1–34.3), 50% (CI 26–74) and 8.1% (CI 3.2–12.9), 22.3% (CI 18.2–26.3), 43.7% (CI 25.6–61.9) using the RGS. The AUC for the WS and RGS for patients aged ≥65 was 0.632 (CI 0.574–0.691) and 0.610 (CI 0.555–0.666). The difference between the AUCs was not statistically significant (p = .441). Conclusion In the population for this study, the WS and RGS have the same PE diagnostic accuracy in patients over age 65. This result should be validated in a prospective study that directly compares these Scores.
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comparison of the unstructured clinician gestalt the wells Score and the revised Geneva Score to estimate pretest probability for suspected pulmonary embolism
Annals of Emergency Medicine, 2013Co-Authors: Andrea Penaloza, Franck Verschuren, Guy Meyer, Sybille Quentingeorget, Caroline Soulie, Frederic Thys, Pierre-marie RoyAbstract:Study objective: The assessment of clinical probability (as low, moderate, or high) with clinical decision rules has become a cornerstone of diagnostic strategy for patients with suspected pulmonary embolism, but little is known about the use of physician gestalt assessment of clinical probability. We evaluate the performance of gestalt assessment for diagnosing pulmonary embolism. Methods: We conducted a retrospective analysis of a prospective observational cohort of consecutive suspected pulmonary embolism patients in emergency departments. Accuracy of gestalt assessment was compared with the Wells Score and the revised Geneva Score by the area under the curve (AUC) of receiver operating characteristic curves. Agreement between the 3 methods was determined by κ test. Results: The study population was 1,038 patients, with a pulmonary embolism prevalence of 31.3%. AUC differed significantly between the 3 methods and was 0.81 (95% confidence interval [CI] 0.78 to 0.84) for gestalt assessment, 0.71 (95% CI 0.68 to 0.75) for Wells, and 0.66 (95% CI 0.63 to 0.70) for the revised Geneva Score. The proportion of patients categorized as having low clinical probability was statistically higher with gestalt than with revised Geneva Score (43% versus 26%; 95% CI for the difference of 17%=13% to 21%). Proportion of patients categorized as having high clinical probability was higher with gestalt than with Wells (24% versus 7%; 95% CI for the difference of 17%=14% to 20%) or revised Geneva Score (24% versus 10%; 95% CI for the difference of 15%=13% to 21%). Pulmonary embolism prevalence was significantly lower with gestalt versus clinical decision rules in low clinical probability (7.6% for gestalt versus 13.0% for revised Geneva Score and 12.6% for Wells Score) and non-high clinical probability groups (18.3% for gestalt versus 29.3% for Wells and 27.4% for revised Geneva Score) and was significantly higher with gestalt versus Wells Score in high clinical probability groups (72.1% versus 58.1%). Agreement between the 3 methods was poor, with all κ values below 0.3. Conclusion: In our retrospective study, gestalt assessment seems to perform better than clinical decision rules because of better selection of patients with low and high clinical probability.
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Comparison of the revised Geneva Score with the Wells rule for assessing clinical probability of pulmonary embolism.
Journal of Thrombosis and Haemostasis, 2008Co-Authors: Frederikus A Klok, Mathilde Nijkeuter, Marc Righini, Arnaud Perrier, Grégoire Le Gal, E. Kruisman, J. Spaan, D. Aujesky, Pierre-marie Roy, Menno V HuismanAbstract:BACKGROUND: The revised Geneva Score, a standardized clinical decision rule in the diagnosis of pulmonary embolism (PE), was recently developed. The Wells clinical decision is widely used but lacks full standardization, as it includes subjective clinician's judgement. We have compared the performance of the revised Geneva Score with the Wells rule, and their usefulness for ruling out PE in combination with D-dimer measurement. METHODS: In 300 consecutive patients, the clinical probability of PE was assessed prospectively by the Wells rule and retrospectively using the revised Geneva Score. Patients comprised a random sample from a single center, participating in a large prospective multicenter diagnostic study. The predictive accuracy of both Scores was compared by area under the curve (AUC) of receiver operating characteristic (ROC) curves. RESULTS: The overall prevalence of PE was 16%. The prevalence of PE in the low-probability, intermediate-probability and high-probability categories as classified by the revised Geneva Score was similar to that of the original derivation set. The performance of the revised Geneva Score as measured by the AUC in a ROC analysis did not differ statistically from the Wells rule. After 3 months of follow-up, no patient classified into the low or intermediate clinical probability category by the revised Geneva Score and a normal D-dimer result was subsequently diagnosed with acute venous thromboembolism. CONCLUSIONS: This study suggests that the performance of the revised Geneva Score is equivalent to that of the Wells rule. In addition, it seems safe to exclude PE in patients by the combination of a low or intermediate clinical probability by the revised Geneva Score and a normal D-dimer level. Prospective clinical outcome studies are needed to confirm this latter finding.
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prediction of pulmonary embolism in the emergency department the revised Geneva Score
Annals of Internal Medicine, 2006Co-Authors: Gregoire Le Gal, Pierre-marie Roy, Marc Philip Righini, Olivier Sanchez, Drahomir Aujesky, Henri Bounameaux, Arnaud PerrierAbstract:To improve diagnosis of pulmonary embolism (PE), the authors constructed a simple scoring system to estimate the probability of PE. Clinical predictors included age, previous venous thromboembolism...