Scales for assessing the clinical probability of PE are used in stable patients (without shock, without hypotension) with suspected pulmonary embolism. They allow you to determine the sequence of diagnostic procedures to confirm or exclude the diagnosis of pulmonary embolism.
Solid or hematologic malignant condition, currently active or considered cured < 1 year:
< 75 bpm
|Probability||Score||Range of points||Clinical advice|
|Age > 65||1|
|Previous DVT or PE||3|
|Surgery (under general anesthesia) or lower limb fracture in past month||2|
|Active malignant condition Solid or hematologic malignant condition, currently active or considered cured < 1 year||2|
|Unilateral lower limb pain||3|
|Heart rate||< 75 bpm||0|
|Pain on lower limb palpation and unilateral edema||4|
Interpretation of obtained results (clinical probability of PE)
|Low probability||0–3 points||Perform D-dimer testing: -if D-dimer testing is negative consider stopping workup, -if D-dimer testing is positive consider CT-angiography|
|Intermediate probability||4-10 points||Perform D-dimer testing: -if D-dimer testing is negative consider stopping workup, -if D-dimer testing is positive consider CT-angiography|
|High probability||≥11 points||Consider CT-angiography|
- Ceriani E, Combescure C, Le Gal G, Nendaz M, Perneger T, Bounameaux H, Perrier A, Righini M. Clinical prediction rules for pulmonary embolism: a systematic review and meta-analysis. J Thromb Haemost. 2010 May;8(5):957-70. doi: 10.1111/j.1538-7836.2010.03801.x. Epub 2010 Feb 2. PMID: 20149072.
- Le Gal G, Righini M, Roy PM, Sanchez O, Aujesky D, Bounameaux H, Perrier A. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006 Feb 7;144(3):165-71. doi: 10.7326/0003-4819-144-3-200602070-00004. PMID: 16461960.
- Klok FA, Kruisman E, Spaan J, Nijkeuter M, Righini M, Aujesky D, Roy PM, Perrier A, Le Gal G, Huisman MV. Comparison of the revised Geneva score with the Wells rule for assessing clinical probability of pulmonary embolism. J Thromb Haemost. 2008 Jan;6(1):40-4. doi: 10.1111/j.1538-7836.2007.02820.x. Epub 2007 Oct 29. PMID: 17973649.
- Penaloza A, Verschuren F, Meyer G, Quentin-Georget S, Soulie C, Thys F, Roy PM. Comparison of the unstructured clinician gestalt, the wells score, and the revised Geneva score to estimate pretest probability for suspected pulmonary embolism. Ann Emerg Med. 2013 Aug;62(2):117-124.e2. doi: 10.1016/j.annemergmed.2012.11.002. Epub 2013 Feb 21. PMID: 23433653.
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