Table 21Clinical score and D-dimer – Quality assessment

OutcomeNumber of studiesDesignLimitationsInconsistencyIndirectnessImprecision
Wells score (revised)262 plus quantitative D-dimer (VIDAS D-dimer, Tinaquant, automated)
Number of PE cases missed 4,78,233,2494CohortsNo serious limitationsNo serious inconsistencySerious indirectness (a)No serious imprecision
Wells score (revised)262 plus semi-quantitative/qualitative D-dimer (Simplify, SimpliRED)
Number of PE cases missed 2051CohortsSerious limitations (b)No serious inconsistencySerious indirectness (c)No serious imprecision
Wells score (original)264 plus semi-quantitative/qualitative D-dimer (Simplify, SimpliRED)
Number of PE cases missed 128,2632CohortsSerious limitations (c)No serious inconsistencySerious indirectness (c)No serious imprecision
Geneva score (original)266 plus quantitative D-dimer (VIDAS D-dimer, Tinaquant)
Number of PE cases missed 8,1912CohortsVery serious limitations (d)No serious inconsistencySerious indirectness (e)No serious imprecision
Geneva score (revised) 136 plus quantitative D-dimer (VIDAS D-dimer, Tinaquant)
Percentage of patients ruled out 2031CohortsSerious limitations (f)No serious inconsistencySerious indirectness (f)No serious imprecision
Charlotte rule127 plus semiquantitative D-dimer
Number of PE cases missed 1281CohortsSerious limitations (c)No serious inconsistencySerious indirectness (c)No serious imprecision
a

One study 4 recruited less than 50% of patients screened. In two studies,78,249 2.4% and 10% of patients violated the protocol (had extra imaging).

b

Patients were enrolled when presenting at the nuclear medicine department. Unclear whether this is consecutive patients presenting with symptoms. Less than 50% of screened patients enrolled.

c

Screening and inclusion criteria unclear. Unclear what percentage of patients screened were enrolled. In one study 128, some clinicians may order imaging tests in negative D-dimer patients - unclear why or how many.

d

Clinicians allowed to overrule the Geneva scoring classification (using “clinical judgement”), it is unclear how many cases were overruled, and what were the criteria for overruling (one study which was excluded reported up to about 40%)

e

Unclear whether results are reproducible if applied to guideline populations.

f

Clinicians allowed to overrule Geneva score rating – cases and criteria described. However percentage of PE cases missed using this method is not reported.

From: 6, Diagnosis of pulmonary embolism

Cover of Venous Thromboembolic Diseases
Venous Thromboembolic Diseases: The Management of Venous Thromboembolic Diseases and the Role of Thrombophilia Testing [Internet].
NICE Clinical Guidelines, No. 144.
National Clinical Guideline Centre (UK).
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