背景:在VTE诊断过程中,在影像学检查之前,用VTE风险评分评估VTE可能性是必不可少的。在临床怀疑为VTE的非手术住院患者指南中,关于VTE风险评分中VTE诊断的预测能力差异知之甚少。
方法:进行了一项回顾性研究,以比较Wells之间VTE诊断的预测能力,日内瓦多年来,PERC,帕多瓦,在主要权威指南中提高非手术住院疑似VTE患者的评分。
结果:在3168名疑似静脉血栓栓塞的非手术住院患者中,最终在2733例(86.3%)中排除了VTE,而在435例(13.7%)中证实。由Wells产生的敏感性和特异性,日内瓦多年来,PERC,帕多瓦,和提高分数(90.3%,49.8%),(88.7%,53.6%),(73.8%,50.2%),(97.7%,16.9%),(80.9%,44.0%),和(78.2%,47.0%),分别。井的YI分别为0.401、0.423、0.240、0.146、0.249和0.252,日内瓦多年来,PERC,帕多瓦,提高分数,分别。C指数为0.694(0.626-0.762),0.697(0.623-0.772),0.602(0.535-0.669),0.569(0.486-0.652),0.607(0.533-0.681),油井为0.609(0.538-0.680),日内瓦多年来,PERC,帕多瓦,提高分数,分别。在Wells与Geneva的成对比较中,一致性是显着的(Kappa0.753,P=0.565),年与帕多瓦(Kappa0.816,P=0.565),年数与改善数(Kappa0.771,P=0.645),和帕多瓦与改善(卡帕0.789,P=0.812),而它在其他对中不存在。PERC的YI提高到0.304、0.272和0.264(AUC0.631[0.547-0.714],P=0.006),帕多瓦(AUC0.613[0.527-0.700],P=0.017),和改善(AUC0.614[0.530-0.698],P=0.016),修订后的截止值为5或更小,6或更多,4或更多表示VTE的可能性,分别。
结论:对于疑似静脉血栓栓塞的非手术住院患者,日内瓦和威尔斯的得分表现最好,PERC分数表现最差,尽管它的灵敏度很高,而其他人是中间人,尽管所有孤立分数的绝对预测能力都很平庸。PERC的预测能力,帕多瓦,通过修订的截止值,提高了分数。
BACKGROUND: The assessment of VTE likelihood with VTE risk scores is essential prior to imaging examinations during VTE diagnostic procedure. Little is known with respect to the disparity of predictive power for VTE diagnosis among VTE risk scores in
guidelines for nonsurgical hospitalized patients with clinically suspected VTE.
METHODS: A retrospective study was performed to compare the predictive power for VTE diagnosis among the Wells, Geneva, YEARS, PERC, Padua, and IMPROVE scores in the leading authoritative
guidelines in nonsurgical hospitalized patients with suspected VTE.
RESULTS: Among 3168 nonsurgical hospitalized patients with suspected VTE, VTE was finally excluded in 2733(86.3%) ones, whereas confirmed in 435(13.7%) ones. The sensitivity and specificity resulted from the Wells, Geneva, YEARS, PERC, Padua, and IMPROVE scores were (90.3%, 49.8%), (88.7%, 53.6%), (73.8%, 50.2%), (97.7%,16.9%), (80.9%, 44.0%), and (78.2%, 47.0%), respectively. The YI were 0.401, 0.423, 0.240, 0.146, 0.249, and 0.252 for the Wells, Geneva, YEARS, PERC, Padua, and IMPROVE scores, respectively. The C-index were 0.694(0.626-0.762), 0.697(0.623-0.772), 0.602(0.535-0.669), 0.569(0.486-0.652), 0.607(0.533-0.681), and 0.609(0.538-0.680) for the Wells, Geneva, YEARS, PERC, Padua, and IMPROVE scores, respectively. Consistency was significant in the pairwise comparison of Wells vs Geneva(Kappa 0.753, P = 0.565), YEARS vs Padua(Kappa 0.816, P = 0.565), YEARS vs IMPROVE(Kappa 0.771, P = 0.645), and Padua vs IMPROVE(Kappa 0.789, P = 0.812), whereas it did not present in the other pairs. The YI was improved to 0.304, 0.272, and 0.264 for the PERC(AUC 0.631[0.547-0.714], P = 0.006), Padua(AUC 0.613[0.527-0.700], P = 0.017), and IMPROVE(AUC 0.614[0.530-0.698], P = 0.016), with a revised cutoff of 5 or less, 6 or more, and 4 or more denoting the VTE-likely, respectively.
CONCLUSIONS: For nonsurgical hospitalized patients with suspected VTE, the Geneva and Wells scores perform best, the PERC scores performs worst despite its significantly high sensitivity, whereas the others perform intermediately, albeit the absolute predictive power of all isolated scores are mediocre. The predictive power of the PERC, Padua, and IMPROVE scores are improved with revised cutoffs.