Clinical prediction rules for pulmonary embolism: a systematic review and meta-analysis.

Abstract

SUMMARY BACKGROUND Pretest probability assessment is necessary to identify patients in whom pulmonary embolism (PE) can be safely ruled out by a negative D-dimer without further investigations. OBJECTIVE Review and compare the performance of available clinical prediction rules (CPRs) for PE probability assessment. PATIENTS/METHODS We identified studies that evaluated a CPR in patients with suspected PE from Embase, Medline and the Cochrane database. We determined the 95% confidence intervals (CIs) of prevalence of PE in the various clinical probability categories of each CPR. Statistical heterogeneity was tested. RESULTS We identified 9 CPR and included 29 studies representing 31215 patients. Pooled prevalence of PE for three-level scores (low, intermediate or high clinical probability) was: low, 6% (95% CI, 4-8), intermediate, 23% (95% CI, 18-28) and high, 49% (95% CI, 43-56) for the Wells score; low, 13% (95% CI, 8-19), intermediate, 35% (95% CI, 31-38) and high, 71% (95% CI, 50-89) for the Geneva score; low, 9% (95% CI, 8-11), intermediate, 26% (95% CI, 24-28) and high, 76% (95% CI, 69-82) for the revised Geneva score. Pooled prevalence for two-level scores (PE likely or PE unlikely) was 8% (95% CI,6-11) and 34% (95% CI,29-40) for the Wells score, and 6% (95% CI, 3-9) and 23% (95% CI, 11-36) for the Charlotte rule. CONCLUSION Available CPR for assessing clinical probability of PE show similar accuracy. Existing scores are, however, not equivalent and the choice among various prediction rules and classification schemes (three- versus two-level) must be guided by local prevalence of PE, type of patients considered (outpatients or inpatients) and type of D-dimer assay applied.

DOI: 10.1111/j.1538-7836.2010.03801.x
0204060802011201220132014201520162017
Citations per Year

259 Citations

Semantic Scholar estimates that this publication has 259 citations based on the available data.

See our FAQ for additional information.

Cite this paper

@article{Ceriani2010ClinicalPR, title={Clinical prediction rules for pulmonary embolism: a systematic review and meta-analysis.}, author={Elisa Ceriani and Christophe Combescure and Gregoire Le Gal and Mathieu R. Nendaz and Thomas Perneger and Henri Bounameaux and A Perrier and Marc Righini}, journal={Journal of thrombosis and haemostasis : JTH}, year={2010}, volume={8 5}, pages={957-70} }