title: Prognostic value of the Geneva prediction rule in patients with pulmonary embolism.
abstract: BACKGROUND
  Assessment of pre-test probability of pulmonary embolism (PE) and prognostic stratification are two widely recommended steps in the management of patients with suspected PE. Some items of the Geneva prediction rule may have a prognostic value. We analyzed whether the initial probability assessed by the Geneva rule was associated with the outcome of patients with PE.
  
  
  METHODS
  In a post-hoc analysis of a multicenter trial including 1,693 patients with suspected PE, the all-cause death or readmission rates during the 3-month follow-up of patients with confirmed PE were analyzed. PE probability group was prospectively assessed by the revised Geneva score (RGS). Similar analyses were made with the a posteriori-calculated simplified Geneva score (SGS).
  
  
  RESULTS
  PE was confirmed in 357 patients and 21 (5.9%) died during the 3-month follow-up. The mortality rate differed significantly with the initial RGS group, as with the SGS group. For the RGS, the mortality increased from 0% (95% Confidence Interval: [0-5.4%]) in the low-probability group to 14.3% (95% CI: [6.3-28.2%]) in the high-probability group, and for the SGS, from 0% (95% CI: [0-5.4%] to 17.9% (95% CI: [7.4-36%]). Readmission occurred in 58 out of the 352 patients with complete information on readmission (16.5%). No significant change of readmission rate was found among the RGS or SGS groups.
  
  
  CONCLUSIONS
  Returning to the initial PE probability evaluation may help clinicians predict 3-month mortality in patients with confirmed PE. (ClinicalTrials.gov: NCT00117169).
authors.affiliation: Division of Angiology and Haemostasis, Department of Internal Medicine, Geneva Faculty of Medicine, University of Geneva, CH-1211 Geneva, Switzerland. laurent.bertoletti@gmail.com
authors.forename: Laurent
authors.initials: L
authors.lastname: Bertoletti
authors.forename: Grégoire
authors.initials: G
authors.lastname: Le Gal
authors.forename: Drahomir
authors.initials: D
authors.lastname: Aujesky
authors.forename: Olivier
authors.initials: O
authors.lastname: Sanchez
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Roy
authors.forename: Franck
authors.initials: F
authors.lastname: Verschuren
authors.forename: Henri
authors.initials: H
authors.lastname: Bounameaux
authors.forename: Arnaud
authors.initials: A
authors.lastname: Perrier
authors.forename: Marc
authors.initials: M
authors.lastname: Righini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000401:mortality
keywords: CI; CT; MDCTA; OR; Odds Ratio; PE; PESI; Pulmonary Embolism Severity Index; Pulmonary embolism; RGS; Revised Geneva Score; SGS; Simplified Geneva Score; V/Q; clinical prediction rule; computed tomography; confidence intervals; death; multidetector computed tomography angiography; prognosis; pulmonary embolism; readmission; ventilation-perfusion scintigraphy