Prediction of Pretest Probability Scoring Systems in Pulmonary Embolism: Wells, Kline and Geneva


Pulmonary embolism (PE) is a clinical entity with high mortality rate and therefore rapid diagnosis is necessary. For this purpose many diagnostic strategies have been developed for avoiding or necessitating further investigations. The hallmark of these strategies is assessing the pretest clinic probability of PE. In this study, the effectiveness of Wells, Geneva and Kline methods were investigated in a university hospital emergency department. 74 patients were enrolled in this study. The inter-group differences in scoring systems were significant for Wells and Kline but non-significant for Geneva method. The diagnosis of PE was correlated with Wells and Kline system but Geneva system lacked it. The Receiver Operating Characteristic analyses was performed for comparing the pretest clinical probability scoring systems and the greatest area under the curve was found in Wells system. Wells method seems more useful compared to Geneva and Kline methods particularly in emergency department.

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Arslan, E. , Yesilaras, S. , Kavalci, C. , Bozkurt, S. , Yilmaz, F. , Durdu, T. , Karakilic, M. and Kavalci, G. (2012) Prediction of Pretest Probability Scoring Systems in Pulmonary Embolism: Wells, Kline and Geneva. International Journal of Clinical Medicine, 3, 731-735. doi: 10.4236/ijcm.2012.37A128.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] C. N. Schoenfeld, “Pulmonary Embolism,” In: J. E. Tintinalli, G. D. Kelen and J. S. Stapczynski, Eds., Emergency Medicine: A Comprehensive Study Guide, 5th Edition, McGraw Hill, NewYork, 2000, pp. 396-401.
[2] J. H. Marieke, A. Kruip, et al., “Diagnostic Strategies for Excluding Pulmonary Embolism in Clinical Outcome Studies,” Annals of Internal Medicine, Vol. 138, No. 12, 2003, pp. 941-951.
[3] C. F. Fied, “Venous Thrombosis and Pulmonary Embolism,” In: P. Rosen and R. M. Barkin, Eds, Rosen’s Emergency Medicine Concepts and Clinical Practise, 5th Edition, Mosby-Yearbook Inc., Toronto, 2002. pp. 1210-1235.
[4] P. S. Wells, J. S. Ginsberg, D. R. Anderson, et al., “Use of a Clinical Model for Safe Management of Patients with Suspected Pulmonary Embolism,” Annals of Internal Medicine, Vol. 129, No. 12, 1998, pp. 997-1005.
[5] J. Wicki, T. V. Perneger and A. F. Junod, “Assessing Clinical Probability of Pulmonary Embolism in the Emergency Ward: A Simple Score,” Archives of Internal Medicine, Vol. 161, No. 1, 2001, pp. 92-97. doi:10.1001/archinte.161.1.92
[6] C. Kearon, “Diagnosis of Pulmonary Embolism,” Canadian Medical Association Journal, Vol. 168, No. 2, 2003, pp. 183-194.
[7] British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group, “British Thoracic Society Guidelines for the Management of Suspected Acute Pulmonary Embolism,” Thorax, Vol. 58, 2003, pp. 470-484. doi:10.1136/thorax.58.6.470
[8] J. A. Kline, R. D. Nelson, R. E. Jackson, et al., “Criteria for the Safe Use of D-Dimer Testing in Emergency Department Patients with Suspected Pulmonary Embolism: A Multicenter US Study,” Annals of Emergency Medicine, Vol. 39, No. 2, 2002, pp. 144-152. doi:10.1067/mem.2002.121398
[9] I. Chagnon, H. Bounameaux and D. Aujesky, “Comparison of Two Clinical Prediction Rules and ?mplicit Assessment among Patients with Suspected Pulmonary Embolism,” American Journal of Medicine, Vol. 113, No. 4, 2002, pp. 269-275. doi:10.1016/S0002-9343(02)01212-3
[10] L. K. Moores, J. F. Collen, K. M. Woods, et al., “Practical Utility of Clinical Prediction Rules for Suspected Acute Pulmonary Embolism in a Large Academic Institution,” Thrombosis Research, Vol. 113, No. 1, 2004, pp. 1-6. doi:10.1016/j.thromres.2004.01.011
[11] M. Miniati, M. Bottai and S. Donti, “Comparison of 3 Clinical Models for Predicting the Probability of Pulmonary Embolism,” Medicine (Baltimore), Vol. 84, No. 2, 2005, pp. 107-114. doi:10.1097/
[12] C. Kabrhel, A. T. McAfee and S. Z. Goldhaber, “The Probability of Pulmonary Embolism Is a Function Diagnoses Considered Most Likely before Testing,” Academic Emergency Medicine, Vol. 13, No. 4, 2006, pp. 471-474. doi:10.1111/j.1553-2712.2006.tb00332.x
[13] ACEP Clinical Policies Committee and the Clinical Policies Subcommittee on Suspected Pulmonary Embolism, “Clinical Policy: Critical ?ssues in the Evaluation and Management of Adult Patients Presenting with Suspected Pulmonary Embolism,” Annals of Emergency Medicine, Vol. 41, No. 2, 2003, pp. 257-270. doi:10.1067/mem.2003.40
[14] C. Kroegel and A. Reissig, “Principal Mechanisms Underlying Venous Thromboembolism: Epidemiology, Risk Factors, Pathophysiology and Pathogenesis,” Respiration, 2003, Vol. 70, No. 1, pp. 7-30. doi:10.1159/000068427
[15] C. T. Ulukavak, N. K?ktürk, N. Demir, K. I. O?uzülgen and N. Ekim, “Comparison of Three Clinical Prediction Rules among Patients with Suspected Pulmonary Embolism,” Tuberk Toraks, Vol. 53, No. 3, 2005, pp. 252-258.

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