Objective: To explore whether acute pulmonary embolism (APE) can be quantitatively predicated early with 3 clinical scoring systems, with multidetector CT angiography (MDCTA) as the gold standard, and therefore to select a scoring system more suitable for the Chinese.
Methods: Five hundred and seventy consecutive inpatients with highly suspected APE underwent prospective MDCTA at the time of initial diagnosis. Three clinical predication scoring systems (Wells', Geneva' and revised Geneva') were used to estimate APE in low, moderate and high probability groups. Two radiologists independently reviewed the MDCTA without any clinical information. When consensus could not be reached, a third radiologist with 20-years' experience was asked to make the final decision. The threshold value for the prediction of APE by the 3 scoring systems was measured by receiver-operating-characteristics (ROC) analysis.
Results: APE was identified in 169 of the 570 cases. Kappa analysis for the 3 scoring systems revealed a low level of agreement: 0.269-0.374, P<0.05. The result of the Geneva score was consistent with that of the revised Geneva score, between them there was an excellent correlation. The positive predictive values of Wells, Geneva, revised Geneva scores for APE were 83.8%, 53.3%, and 61.3% respectively, while the negative predictive values were 85.0%, 80.6%, and 80.0%, respectively. ROC analysis showed that the area under curve (AUC) of Wells, Geneva and revised Geneva score for APE was 0.823 (95% CI: 0.710-0.976), 0.677 (95% CI: 0.646-0.990), and 0.661 (95% CI: 0.631-0.983), respectively. The Wells score showed the best discriminatory ability as compared to the other 2 scores.
Conclusion: The 3 scoring systems can be used for both inpatients and emergency cases, while the Wells Score may be more accurate for Chinese people for predicting APE.