A study of modified Wells score for pulmonary embolism and age-adjusted D-dimer values in patients at risk for deep venous thrombosis
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1Department of Medicine, Lady Hardinge Medical College and Dr. Ram Manohar Lohia Hospital, New Delhi, India.
Aims:
Pulmonary embolism (PE) is the most severe complication of deep venous thrombosis (DVT). This study was designed to evaluate the usefulness of modified Wells score combined with age-adjusted D-dimer cut-off levels as a clinical pre-test probability assessment for predicting PE in patients 'at risk for DVT.'
Methods:
This was a cross-sectional study including 200 in-patients at risk for DVT. Patients were categorized as 'pulmonary embolism unlikely' or 'pulmonary embolism likely' using modified Wells score and underwent D-dimer testing. PE was considered excluded in patients classified as unlikely with normal D-dimer levels, whereas the rest of the patients underwent computed tomography pulmonary angiogram (CTPA).
Results:
Out of 200 patients, 163 patients (81.50%) were 'pulmonary embolism unlikely,' whereas 37 patients (18.50%) were 'pulmonary embolism likely.' Of 163 patients categorized as 'pulmonary embolism unlikely,' 67 patients (41.5%) had normal D-dimer values and were excluded from CTPA. PE was detected in 24.2% of the patients who underwent CTPA.
Conclusion:
The combined strategy using modified Wells score and age-adjusted D-dimer cut-off value has 100% sensitivity and a negative predictive value and can be used to safely exclude PE in in-patients.
