title: Values of the Wells and revised Geneva scores combined with D-dimer in diagnosing elderly pulmonary embolism patients.
abstract: BACKGROUND
  Pulmonary embolism (PE) can be difficult to diagnose in elderly patients because of the coexistent diseases and the combination of drugs that they have taken. We aimed to compare the clinical diagnostic values of the Wells score, the revised Geneva score and each of them combined with D-dimer for suspected PE in elderly patients.
  
  
  METHODS
  Three hundred and thirty-six patients who were admitted for suspected PE were enrolled retrospectively and divided into two groups based on age (≥65 or <65 years old). The Wells and revised Geneva scores were applied to evaluate the clinical probability of PE, and the positive predictive values of both scores were calculated using computed tomography pulmonary arteriography as a gold standard; overall accuracy was evaluated by the area under the curve (AUC) of receiver operator characteristic curve; the negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were calculated.
  
  
  RESULTS
  Ninety-six cases (28.6%) were definitely diagnosed as PE among 336 cases, among them 56 cases (58.3%) were ≥65 years old. The positive predictive values of Wells and revised Geneva scores were 65.8% and 32.4%, respectively (P < 0.05) in the elderly patients; the AUC for the Wells score and the revised Geneva score in elderly was 0.682 (95% confidence interval [CI]: 0.612-0.746) and 0.655 (95% CI: 0.584-0.722), respectively (P = 0.389). The negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were 93.7%, 100%, and 100% in the elderly, respectively.
  
  
  CONCLUSIONS
  The diagnostic value of the Wells score was higher than the revised Geneva score for the elderly cases with suspected PE. The combination of either the Wells score or the revised Geneva score with a normal D-dimer concentration is a safe strategy to rule out PE.
authors.affiliation: Department of Cardiology, Peking University People's Hospital, Beijing 100044, China.
authors.forename: Dan-Jie
authors.initials: DJ
authors.lastname: Guo
authors.forename: Can
authors.initials: C
authors.lastname: Zhao
authors.forename: Ya-Dan
authors.initials: YD
authors.lastname: Zou
authors.forename: Xu-Hang
authors.initials: XH
authors.lastname: Huang
authors.forename: Jing-Min
authors.initials: JM
authors.lastname: Hu
authors.forename: Lin
authors.initials: L
authors.lastname: Guo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism*; D012189:Retrospective Studies
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D