title: Diagnostic Performance of Wells Score Combined With Point-of-care Lung and Venous Ultrasound in Suspected Pulmonary Embolism.
abstract: Lung and venous ultrasound are bedside diagnostic tools increasingly used in the early diagnostic approach of suspected pulmonary embolism (PE). However, the possibility of improving the conventional prediction rule for PE by integrating ultrasound has never been investigated.
  
  
  
  We performed lung and venous ultrasound in consecutive patients suspected of PE in four emergency departments. Conventional Wells score (Ws) was adjudicated by the attending physician, and ultrasound was performed by one of 20 investigators. Signs of deep venous thrombosis (DVT) at venous ultrasound and signs of pulmonary infarcts or alternative diagnoses at lung ultrasound were considered to recalculate two items of the Ws: signs and symptoms of DVT and alternative diagnosis less likely than PE. The diagnostic performances of the ultrasound-enhanced Ws (USWs) and Ws were then compared after confirmation of the final diagnosis.
  
  
  
  A total of 446 patients were studied. PE was confirmed in 125 patients (28%). USWs performed significantly better than Ws, with a sensitivity of 69.6% versus 57.6% and a specificity of 88.2% versus 68.2%. In combination with D-dimer, USWs showed an optimal failure rate (0.8%) and a significantly superior efficiency than Ws (32.3% vs. 27.2%). A strategy based on lung and venous ultrasound combined with D-dimer would allow to avoid CT pulmonary angiography in 50.5% of patients with suspected PE, compared to 27.2% when the rule without ultrasound is applied.
  
  
  
  A pretest risk stratification enhanced by ultrasound of lung and venous performs better than Ws in the early diagnostic process of PE.
authors.affiliation: Department of Emergency Medicine, Careggi University Hospital, Firenze.
authors.forename: Peiman
authors.initials: P
authors.lastname: Nazerian
authors.affiliation: Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Volpicelli
authors.affiliation: Department of Emergency Medicine, Careggi University Hospital, Firenze.
authors.forename: Chiara
authors.initials: C
authors.lastname: Gigli
authors.affiliation: Department of Internal Medicine, University Hospital of Perugia, Perugia.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Becattini
authors.affiliation: Respiratory Unit, Dipartimento Scienze della Salute, San Paolo Hospital, Università degli Studi di Milano, Milano.|Casa di Cura del Policlinico, Dipartimento di Scienze Neuroriabilitative, Milano, Italy.
authors.forename: Giuseppe Francesco
authors.initials: GF
authors.lastname: Sferrazza  Papa
authors.affiliation: Department of Emergency Medicine, Careggi University Hospital, Firenze.
authors.forename: Stefano
authors.initials: S
authors.lastname: Grifoni
authors.affiliation: Department of Emergency Medicine, Careggi University Hospital, Firenze.
authors.forename: Simone
authors.initials: S
authors.lastname: Vanni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012306:Risk; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D