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ARTICLE

Prediction of Pulmonary Embolism in the Emergency Department: The Revised Geneva Score

Grégoire Le Gal, MD; Marc Righini, MD; Pierre-Marie Roy, MD; Olivier Sanchez, MD; Drahomir Aujesky, MD, MSc; Henri Bounameaux, MD; and Arnaud Perrier, MD

7 February 2006 | Volume 144 Issue 3 | Pages 165-171

Background: Diagnosis of pulmonary embolism requires clinical probability assessment. Implicit assessment is accurate but is not standardized, and current prediction rules have shortcomings.

Objective: To construct a simple score based entirely on clinical variables and independent from physicians' implicit judgment.

Design: Derivation and external validation of the score in 2 independent management studies on pulmonary embolism diagnosis.

Setting: Emergency departments of 3 university hospitals in Europe.

Patients: Consecutive patients admitted for clinically suspected pulmonary embolism.

Measurements: Collected data included demographic characteristics, risk factors, and clinical signs and symptoms suggestive of venous thromboembolism. The variables statistically significantly associated with pulmonary embolism in univariate analysis were included in a multivariate logistic regression model. Points were assigned according to the regression coefficients. The score was then externally validated in an independent cohort.

Results: The score comprised 8 variables (points): age older than 65 years (1 point), previous deep venous thrombosis or pulmonary embolism (3 points), surgery or fracture within 1 month (2 points), active malignant condition (2 points), unilateral lower limb pain (3 points), hemoptysis (2 points), heart rate of 75 to 94 beats/min (3 points) or 95 beats/min or more (5 points), and pain on lower-limb deep venous palpation and unilateral edema (4 points). In the validation set, the prevalence of pulmonary embolism was 8% in the low-probability category (0 to 3 points), 28% in the intermediate-probability category (4 to 10 points), and 74% in the high-probability category (11 points).

Limitations: Interobserver agreement for the score items was not studied.

Conclusions: The proposed score is entirely standardized and is based on clinical variables. It has sustained internal and external validation and should now be tested for clinical usefulness in an outcome study.

Editors' Notes Context Using clinical findings to estimate the probability of disease can help guide management decisions. Contribution These investigators used data from 2 independent studies to derive and validate an 8-item score for predicting pulmonary embolism in patients seen in the emergency department for suspected embolism. Items addressed age, previous thrombosis, recent surgery or fracture, malignant condition, unilateral leg pain, unilateral leg edema, hemoptysis, and heart rate. The prevalence of pulmonary embolism in patients with low, intermediate, and high scores was 8%, 28%, and 74%, respectively. Implications We should now assess whether using this prediction rule affects patient outcomes. —The Editors

 

Author and Article Information

From Brest University Hospital, Brest, France; Geneva University Hospital, Geneva, Switzerland; Angers University Hospital, Angers, France; Hôpital Européen Georges-Pompidou, Paris, France; and Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Grant Support: By the Hirsch Fund of the University of Geneva, the Swiss National Research Foundation (grant 32-61773.00), the Royal College of Physicians and Surgeons of Canada (grants 97/4-T10 and 00/4-T9), La Fondation Québécoise pour le Progrès de la Médecine Interne and Les Internistes et Rhumatologues Associés de l'Hôpital du Sacré-Cur, and the Direction of Clinical Research of the Angers University Hospital (grant 2001/021).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Grégoire Le Gal, MD, EA 3878, Département de Médecine Interne et Pneumologie, CHU de la Cavale Blanche, 29609 Brest Cedex, France; e-mail, gregoire.legal{at}chu-brest.fr.

Current Author Addresses: Dr. Le Gal: EA 3878, Département de Médecine Interne et Pneumologie, CHU de la Cavale Blanche, 29609 Brest Cedex, France.

Drs. Righini, Bounameaux, and Perrier: Geneva University Hospital, Rue Micheli du Crest 24, 1211 Geneva, Switzerland.

Dr. Roy: Emergency Service, CHU, 4 Rue Larrey, 49033 Angers, France.

Dr. Sanchez: Service of Pneumology, Hôpital Européen Georges-Pompidou, 20 Rue Leblanc, 75015 Paris, France.

Dr. Aujesky: Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011 Lausanne, Switzerland.

Author Contributions: Conception and design: G. Le Gal, M. Righini, H. Bounameaux, A. Perrier.

Analysis and interpretation of the data: G. Le Gal, M. Righini, A. Perrier.

Drafting of the article: G. Le Gal, A. Perrier.

Critical revision of the article for important intellectual content: M. Righini, D. Aujesky, H. Bounameaux.

Final approval of the article: G. Le Gal, M. Righini, P.-M. Roy, O. Sanchez, D. Aujesky, H. Bounameaux, A. Perrier.

Provision of study materials or patients: M. Righini, P.-M. Roy, O. Sanchez, D. Aujesky.

Statistical expertise: G. Le Gal.

Obtaining of funding: H. Bounameaux.

Administrative, technical, or logistic support: O. Sanchez, H. Bounameaux.

Collection and assembly of data: P.-M. Roy, O. Sanchez.

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