title: Prognostic value of the Geneva prediction rule in patients in whom pulmonary embolism is ruled out.
abstract: OBJECTIVE
  The prognosis of patients in whom pulmonary embolism (PE) is suspected but ruled out is poorly understood. We evaluated whether the initial assessment of clinical probability of PE could help to predict the prognosis for these patients.
  
  
  METHODS
  Retrospective analysis of data obtained during a prospective multicentre management study.
  
  
  METHODS
  Six general and teaching hospitals in Belgium, France and Switzerland.
  
  
  METHODS
  In 1334 patients in whom PE was ruled out, 3-month mortality data were available (hospital readmission status was unknown for three patients) and clinical probability was evaluated with the revised Geneva score (RGS).
  
  
  METHODS
  Three-month mortality and readmission rates.
  
  
  RESULTS
  Three-month mortality and readmissions rates were 3% and 19%, respectively and differed significantly depending on the RGS-determined PE probability group (P<0.001). When compared with patients presenting with a low probability, the risk of death after 3 months was higher in cases of intermediate or high RGS-based probability {odds ratio: 8.7 [95% confidence interval (CI): 2.7-28.5] and 22.6 (95%CI: 2.1-241.2), respectively}. The readmission risk increased with PE probability group (P<0.001). The main causes of death were cancer, respiratory failure and cardiovascular failure. In total, 86% of patients with low RGS-based probability were alive and had not been readmitted to hospital, whereas other patients had a twofold increased risk of death or readmission during the 3-month follow-up. The simplified Geneva score, calculated a posteriori, gave similar results.
  
  
  CONCLUSIONS
  Initial assessment of clinical probability may help to stratify prognosis of patients in whom PE has been ruled out. Patients with a low probability of PE have a good prognosis. Whether patients with higher probability might benefit from more vigilant care should be evaluated.
authors.affiliation: Division of Angiology and Haemostasis, Department of Internal Medicine, Geneva Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Bertoletti
authors.forename: G
authors.initials: G
authors.lastname: Le Gal
authors.forename: D
authors.initials: D
authors.lastname: Aujesky
authors.forename: P-M
authors.initials: PM
authors.lastname: Roy
authors.forename: O
authors.initials: O
authors.lastname: Sanchez
authors.forename: F
authors.initials: F
authors.lastname: Verschuren
authors.forename: H
authors.initials: H
authors.lastname: Bounameaux
authors.forename: A
authors.initials: A
authors.lastname: Perrier
authors.forename: M
authors.initials: M
authors.lastname: Righini
mesh_terms: D000328:Adult; D000368:Aged; D001530:Belgium / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000401:mortality; D003661:Decision Support Techniques; D004812:Epidemiologic Methods; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis*; D012131:Respiratory Insufficiency / Q000401:mortality; D013557:Switzerland / Q000453:epidemiology