title: Utility of the simplified Wells and revised Geneva scores to exclude pulmonary embolism in femur fracture patients.
abstract: OBJECTIVE
  The diagnosis of acute pulmonary embolism (PE) in trauma patients is challenging. This study evaluated the diagnostic value of simplified Wells and simplified revised Geneva scores to predict PE in femur fracture patients in emergency department (ED).
  
  
  METHODS
  All consecutive adult patients with femur fractures and elevated D-dimer levels (>0.5μg/mL) who underwent CTPA within 72h of injury from January 2010 to December 2014 were included. The simplified Wells and simplified revised Geneva scores were applied to evaluate the clinical probability of PE.
  
  
  RESULTS
  Among 519 femur fracture patients, 446 patients were finally included, and 23 patients (5.2%) were diagnosed with acute PE. The median values of simplified Wells and simplified revised Geneva scores [0 (IQR: 0-1) vs. 0 (IQR: 0-0), P=0.23; 3 (IQR: 2-4) vs. 3 (IQR: 2-3), P=0.48] showed no differences between the PE (n=23) and non-PE (n=423) groups. Using the simplified Wells score, 98% of the patients were categorized into the "PE unlikely" group. The sensitivity, specificity, positive predictive value, and negative predictive value of the simplified revised Geneva score (≥3 points) for the diagnosis of PE were 74%, 35%, 6%, and 96%, respectively.
  
  
  CONCLUSIONS
  In femur fracture patients with elevated D-dimer levels, the simplified Wells and simplified revised Geneva scores have limited predictive value. However, the simplified revised Geneva score of <3 points may be possibly used as a diagnostic tool.
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Youn-Jung
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Dae-Hee
authors.initials: DH
authors.lastname: Choi
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Eu Sun
authors.initials: ES
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Seung Mok
authors.initials: SM
authors.lastname: Ryoo
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Shin
authors.initials: S
authors.lastname: Ahn
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Chang Hwan
authors.initials: CH
authors.lastname: Sohn
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Dong-Woo
authors.initials: DW
authors.lastname: Seo
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Kyoung Soo
authors.initials: KS
authors.lastname: Lim
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. Electronic address: wonpia73@naver.com.
authors.forename: Won Young
authors.initials: WY
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000503:physiopathology; D015203:Reproducibility of Results; D056910:Republic of Korea; D012189:Retrospective Studies
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: Diagnosis; Femur fracture; Predictive value; Pulmonary embolism; Trauma