| ObjectiveTo compare clinical susceptibility factors commonly used Wells score,modified Geneva score two scoring system in patients with suspected pulmonary embolism diagnosis prediction value and the correlation with CT pulmonary embolism index.MethodFourth in tianjin central hospital were retrospectively analyzed between September 2013 and September 2013 and history of pulmonary embolism during the period of 227 cases of hospitalized patients,exclude qualified into the group of 218 cases,among them,95 cases of male,female 123 cases,aged 27-89,with an average age of 64.03 soil is 12.15 years old,collect and record on general data,including patient age,gender,blood pressure,heart rate,breathing rate,the chief complaint and related clinical symptoms,blood oxygen saturation situation and related chronic disease,cardiopulmonary for ever exist tumor history,merge history of lower extremity deep vein thrombosis and related laboratory examination,CT pulmonary angiography results,etc.Parsing patients all kinds of clinical symptoms,laboratory results and imaging examination,explore its correlation with pulmonary embolism occurs,for all patients in group were applied WELLs rating evaluation and correction of Geneva,according to Qanadli CT patients with confirmed pulmonary congestion index method to calculate and record the plaque index,measurement data using t test,counting data by chi-square test,analysis of multiple factor correlation analysis using Logistie regression analysis and so on,the analysis of related risk factors and the relationship between pulmonary embolism occurs,apply the receiver-operating characteristic curve(ROC curve)evaluation of two clinical scoring systems for patients with pulmonary embolism predictive value as well as the application of Spearman correlation analysis two scoring system,D dimer and the correlation of CT pulmonary embolism index.Results1.General information: into the group of 218 patients,respectively from the ICU in 7 cases,2 cases of liver and gallbladder surgery,anus bowel division 3 cases,orthopaedic 4 cases,23 cases of chest cardiac,vascular surgery,38 cases regions(3cases),tumor onset(3 cases).Eventually the CTPA diagnosed 72 cases,diagnosis rate was 33.0%,male 28 cases,44 cases of women,average age was 66.88 + /-11.60 years old.2.218 cases of suspected in patients with the diagnosis of pulmonary embolism,used Wells score for clinical assessment of suspected pulmonary embolism low-alcohol may for 60 cases,moderate for 122 cases,highly likely for 36 cases,eventually the CTPA diagnosed as pulmonary embolism of low-alcohol respectively 0cases(positive rate 0%),moderate 50 cases(41.The diagnosis rate 0%),height 22cases(positive rate 61.1%).Wells score low final forecast for pulmonary embolism in patients with negative predictive value of 100.0%,and height may eventually forecast for pulmonary embolism in patients with positive predictive value of61.1%.Application of modified Geneva score evaluation in May 68,moderate May109,highly likely,41 cases by CTPA diagnosed with pulmonary embolism there were3 cases(positive rate 4.4%),47 cases(positive rate 43.1%),22 cases(positive rate53.7%),modified Geneva score low final forecast for pulmonary embolism in patients with a negative predictive value of 95.6%,and height may eventually forecast for pulmonary embolism in patients with positive predictive value of53.7%.D-dimer 0.32 20.00(5.88 + 5.71)of ug/ml,was 168 cases(more than 0.5ug/ml),eventually the CTPA diagnosed 71 cases(42.3%),negatie(less than 0.5 ug/ml)50 cases,eventually the CTPA diagnosed in 1 case3.72 patients with confirmed pulmonary artery embolism QanadliCT index by2.5%-2.5%(37.19-20.90),low degree of less than 30% for 25 cases,moderate 30%50% 27 cases,height is more than 50% for 20 cases4.Statistical results and analysis: the risk factors associated with pulmonary embolism occurs between,such as age,DVT symptoms with pulmonary embolism group statistically significant,P < 0.05,in the aspects of symptoms and signs,D-dimer,bosom frowsty,breath with hypoxemia,chest pain,Wells score with pulmonary embolism group statistically significant,P < 0.05).Applying the receiver-operating characteristic curve(ROC curve)to evaluate two clinical scoring systems and D-dimer index of acute pulmonary embolism confirmed predictive value.Wells score area under the ROC curve(AUC)was 0.785 + /-0.030(95% CI0.725 to 0.844,P = 0.725),the correction of Geneva score area under the curve is0.743 + /-0.034(95% CI 0.676 to 0.809,P = 0.676),D-dimer of the area under the ROC curve(AUC)was 0.766 + /-0.032(95% CI 0.703 to 0.828,P = 0.703).Wells score,revised Geneva score and D-dimer area under the ROC curve no statistical difference.About index,calculate their respective shows Wells score best cutoff value is 2.75,corresponding to the pulmonary embolism diagnosis forecast sensitivity of100%,specificity of 54.0%.Revised Geneva score death best cutoff value is 3.5,corresponding to the pulmonary embolism diagnosis forecast sensitivity of 95.8%,specificity of 57.6%,D-dimer best cutoff value is 0.890 ug/ml,corresponding to the pulmonary embolism sensitive perceptual diagnosis was 97.2%,specificity of51.1%.Correlation analysis showed that Wells evaluation and correction of Geneva,D-dimer index were positively correlated with CT pulmonary embolism,correlation analysis of P value(0.000)are less than 0.05,there is statistical significance,correlation,correlation coefficient r value,respectively,0.471,0.387,0.445,the absolute value is less than 0.5,correlation degree is low.Conclusion1.The clinical manifestations of acute pulmonary embolism and the risk factors in age,chest DVT symptoms,rather tight with hypoxemia,chest pain was statistically significant.2.Wells score,modified Geneva score and D-dimer in acute pulmonary embolism has certain prediction value,the study results show that the Wells score better predictive value.3.Computed tomography(CT)pulmonary embolism index and the Geneva score changes to the Wells score,and D-dimer high and low,so the two scoring systems and D-dimer level in predicting severity pulmonary embolism,have certain reference value. |
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