Assessing clinical probability of pulmonary embolism: prospective validation of the simplified geneva score in outpatients.

Abstract Pretest probability assessment by a clinical prediction rule (CPR) is an important step in the management of patients with suspected pulmonary embolism (PE). A limitation to the use of CPR is that their constitutive variables and corresponding number of points are difficult to memorize. A simplified version of the Geneva score (i.e. attributing one point to each variable) has been proposed but never been prospectively validated. Prospective validation of the simplified Geneva score (SGS) and comparison with the previous version of the Geneva score (GS). In the ADJUST-PE study, whose primary aim was to validate the age-adjusted D-dimer cut-off, the SGS was prospectively used to determine the pretest probability in a subsample of 1,621 study patients. Overall, PE was confirmed in 294 (18.1%) patients. Using the SGS, 608 (37.5%), 980 (60.5%), and 33 (2%) were classified as having a low, intermediate and high clinical probability. Corresponding PE prevalences were 9.7%, 22.4% and 45.5%; 490 (30.1%) of patients with low or intermediate probability had a D-dimer level below 500 μg/L and 653 (41.1%) had a negative D-dimer test according to the age-adjusted cut-off. Using the GS, the figures were: 491(30.9%) and 650 (40.9%). None of the patients considered as not having PE based on a low or intermediate SGS and negative D-dimer had a recurrent thromboembolic event during the 3-month follow-up. The use of SGS results in a similar yield and safety than the GS to exclude PE in association with the D-dimer test. This article is protected by copyright. All rights reserved.