title: Comparison of Wells and Revised Geneva Rule to Assess Pretest Probability of Pulmonary Embolism in High-Risk Hospitalized Elderly Adults.
abstract: OBJECTIVE
  To assess and compare the diagnostic power for pulmonary embolism (PE) of Wells and revised Geneva scores in two independent cohorts (training and validation groups) of elderly adults hospitalized in a non-emergency department.
  
  
  METHODS
  Prospective clinical study, January 2011 to January 2013.
  
  
  METHODS
  Unit of Internal Medicine inpatients, University of Catania, Italy.
  
  
  METHODS
  Elderly adults (mean age 76 ± 12), presenting with dyspnea or chest pain and with high clinical probability of PE or D-dimer values greater than 500 ng/mL (N = 203), were enrolled and consecutively assigned to a training (n = 101) or a validation (n = 102) group. The clinical probability of PE was assessed using Wells and revised Geneva scores.
  
  
  METHODS
  Clinical examination, D-dimer test, and multidetector computed angiotomography were performed in all participants. The accuracy of the scores was assessed using receiver operating characteristic analyses.
  
  
  RESULTS
  PE was confirmed in 46 participants (23%) (24 training group, 22 validation group). In the training group, the area under the receiver operating characteristic curve was 0.91 (95% confidence interval (CI) = 0.85-0.98) for the Wells score and 0.69 (95% CI = 0.56-0.82) for the revised Geneva score (P < .001). These results were confirmed in the validation group (P < .05). The positive (LR+) and negative likelihood ratios (LR-) (two indices combining sensitivity and specificity) of the Wells score were superior to those of the revised Geneva score in the training (LR+, 7.90 vs 1.34; LR-, 0.23 vs 0.66) and validation (LR+, 13.5 vs 1.46; LR-, 0.47 vs 0.54) groups.
  
  
  CONCLUSIONS
  In high-risk elderly hospitalized adults, the Wells score is more accurate than the revised Geneva score for diagnosing PE.
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Marca
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Cilia
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Campagna
authors.affiliation: Unit of Statistics, National Research Council, Institute of Clinical Physiology, Institute of Biomedicine and Molecular Immunology, Ospedali Riuniti, Reggio Calabria, Italy.
authors.forename: Graziella
authors.initials: G
authors.lastname: D'Arrigo
authors.affiliation: Unit of Statistics, National Research Council, Institute of Clinical Physiology, Institute of Biomedicine and Molecular Immunology, Ospedali Riuniti, Reggio Calabria, Italy.|Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
authors.forename: Samar
authors.initials: S
authors.lastname: Abd ElHafeez
authors.affiliation: Unit of Statistics, National Research Council, Institute of Clinical Physiology, Institute of Biomedicine and Molecular Immunology, Ospedali Riuniti, Reggio Calabria, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tripepi
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Puccia
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy.
authors.forename: Marcella
authors.initials: M
authors.lastname: Pisano
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Mastrosimone
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Terranova
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Cardella
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy.
authors.forename: Agata
authors.initials: A
authors.lastname: Buonacera
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Stancanelli
authors.affiliation: Unit of Statistics, National Research Council, Institute of Clinical Physiology, Institute of Biomedicine and Molecular Immunology, Ospedali Riuniti, Reggio Calabria, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
authors.affiliation: Unit of Internal Medicine, Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Malatino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D006801:Humans; D007558:Italy; D010343:Patient Admission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000453:epidemiology*; D012720:Severity of Illness Index
keywords: D-dimer; Wells score; elderly adults; pulmonary embolism; revised Geneva score