Predictive Values Of The YEARS Algorithm,Simplified Wells Score,and Modified Geneva Score In The Diagnosis Of Acute Pulmonary Embolism

Objective:To explore and compare the predictive value of YEARS algorithm,simplified Wells score and modified Geneva score in the diagnosis of acute pulmonary embolism,in order to find a scoring model more suitable for clinical suspected acute pulmonary embolism,avoid the missed diagnosis or overdiagnosis of acute pulmonary embolism,so as to reduce the excessive application of computed tomographic pulmonary angiography（CTPA）.Methods:A retrospective analysis was performed on 676 inpatients admitted to our hospital from April 2018 to December 2020 who had undergone CTPA examination due to clinical suspected acute pulmonary embolism.Collected in the patient’s demographic information,medical history,clinical manifestations and auxiliary examination findings.YEARS algorithm,simplified Wells score,and modified Geneva score were performed.CTPA was used as the gold standard for the diagnosis of acute pulmonary embolism and to compare the predictive value of YEARS algorithm,simplified Wells score and modified Geneva score in the diagnosis of acute pulmonary embolism.Results:1.A total of 174（25.7%）patients were diagnosed with pulmonary embolism by CTPA examination.2.The sensitivity and negative predictive values of the YEARS algorithm（89.66%,90.72%,respectively）were significantly higher than those of the simplified Wells scores（66.09%,85.95%）and modified Geneva scores（62.07%,83.33%）.However,its specificity（35.06%）was significantly lower than that of the simplified Wells（71.91%）and Geneva（65.74%）scores.3.ROC curve was used to indicate the predictive value of acute pulmonary embolism,Area under the curve（AUC）of YEARS algorithm,simplified Wells score and modified Geneva score were0.624（95% CI: 0.586-0.660）,0.690（95% CI: 0.654-0.725）and 0.639（95% CI: 0.602-0.675）.The prediction efficiency of simplified Wells score was significantly better than YEARS algorithm and modified Geneva score,and the difference was statistically significant（Z =3.004,P =0.03;Z=2.948,P =0.03）,there was no significant difference between YEARS algorithm and modified Geneva score（Z =3.004,P =0.493）.4.The simplified Wells score had the highest diagnostic odds ratio（DOR = 4.99）,followed by the YEARS algorithm（DOR = 4.68）,and the revised Geneva score is the lowest（DOR = 3.14）.5.Compared with simplified Wells score,d-dimer ≥ 0.5mg/L combined with simplified Wells score significantly increased the specificity and DOR for the diagnosis of pulmonary embolism（74.26% vs.71.91%,and 5.08 vs.4.99,respectively）.Conclusions:1.The sensitivity and negative predictive value of YEARS algorithm were higher,but the diagnostic efficacy was slightly lower than the simplified Wells score.2.Among the three clinical predictive scoring methods,the simplified Wells score has the highest predictive value for the diagnosis of acute pulmonary embolism.3.Combining D-dimer levels of≥0.5mg/L with the simplified Wells score can achieve better diagnostic performance.