The contribution of simplified (modifiye) /modified revised Geneva and Wells clinical prediction scoring to the diagnosis of pulmonary embolism

Introduction: Pulmonary thromboembolism is a disease that has high mortality and morbidity, difficult to diagnose and generally preventable.Therefore, early diagnosis is important.Clinical scoring is used for guiding to early diagnosis. Two of these frequently used scoring are Wells (Canadian) and Simplified Modified Geneva. Aim: Inourstudy; We aimed to determine the value of Wells and Simplified Modified Geneva, which are used in the diagnosis of PTE in patients admitted to the emergency services and chest diseases outpatient clinic and to compare them with each other. Materialsandmethods: In this study, one hundred and ninety-five CTPA examinations of patients with suspected pulmonary embolism who were admitted Dicle University Faculty of Medicine, Department of Emergency Service and Chest Diseases outpatient clinic between May and November 2018 were included. Pulmonary embolism (PTE) was diagnosed with CTPA. The patients were calculated by Wells (Canadian) and Simplified Modified Geneva, the clinical prediction score of pulmonary thromboembolism. Wells Clinical Scoring was dichotomized (2-level) (weakand strong probability), where as the Modified Geneva clinical scoring was grouped as dichotomized (2-level) (possible andunlikely). The analyzes were performed with SPSS package 21 .0 program. Results: One hundred and ninety-five patients were included in the evaluation. One hundred and nine (55.9%) of these patients were admitted to the emergency department and eighty-six (44.1%) patients were admitted to the outpatient clinic of chest diseases. Of all cases, 83 (%42.6) were male and 112 (%57.4) were female. Average age was 57.16 ± 18.62. Of the one hundred and ninety-five CTPA examinations, one hundred and fifty-four (79%) had a negative result and fourty-one (21%) had a positive result. In thiss tudy, the sensitivity of Wells Clinical Scoring for PTE was 87.8% and specificity was 83.8%. Simplified Modified Geneva Clinical Scoring has a sensitivity of 82.9% and a specificity of 53.3% for PTE. Inthechi-square analysis for two clinical scoring results, p value was found to be 0.001 (<0.05). The negative predictive values of Wells and Simplified 7 Modified Geneva Scores were the highest in polyclinics and their percentages are 96.7% and 95.7%. The positive predictive value was the highest in the emergency department and the percentages were 80% and 39.4%. When the two clinical scores were used together, the negative predictive value was calculated as 95.6% and the positive predictive value was 61.1%. Conclusion: We found that Wells Clinical Scoring is superior to the Simplified Modified Geneva Score in terms of sensitivity and specificity. Therefore, Wells Score is more effective than the Simplified Modified Geneva Score in the diagnosis of PTE. The use of these two clinical scores in the outpatient clinic was more useful in exclusion of the diagnosis of embolism; in the emergency department, the diagnosis of embolism was found to be more effective. When the two scores are used together, the negative predictive value is more useful than the positive predictive value and it is more effective in exclusion of the diagnosis of embolism.