Evaluation of Pulmonary Embolism Risk Stratification Scores in Patients Admitted to the Internal Medicine Clinic

Abstract

Aim:Pulmonary embolism (PE) is a common cardiovascular emergency, and a broad range of conditions must be included in the differential diagnosis because of the frequent and highly non-specific symptoms of PE. Risk stratification scores were created because unnecessary procedures are often performed during the diagnostic process. Modified Geneva and Wells scores are widely used scoring systems, but their reliability remains controversial. In our study, we evaluated these scoring systems according to the predictability of the diagnosis and its correlation with mortality in patients diagnosed with PE.Methods:Our study was conducted in a single center with a retrospective, cross-sectional design. We included 108 patients diagnosed with PE and admitted to the internal medicine clinic between January 2016 and October 2019. The median follow-up period was 19 months. The patients’ initial demographic, clinical, and radiological findings were recorded. The modified Wells, Wells, and Modified Geneva risk scores were calculated according to this information. The relationships among laboratory findings, risk scores, and mortality were evaluated.Results:It was determined that 48 (44%) of the patients died, and 57 (53%) survived during the follow-up period. The death or survival information of three patients could not be obtained because of their foreign nationality. There was no significant difference between the mean ages of female and male patients (p=839). The relationship between patient evaluations according to the score systems and mortality was examined. The analysis determined that only the Modified Geneva score had a significant association with mortality (p=0.001). In contrast, the Wells and Modified Wells scores had no statistically significant relationship with mortality (p=0.396 and 0.391, respectively). Age, malignancy, and dyspnea at admission were independent factors affecting mortality (p=0.001, 0.026, and 0.023, respectively).Conclusion:The risk stratification scoring systems’ diagnosis and mortality predictability are insufficient. These scoring systems must be improved to prevent underdiagnosis and unnecessary testing.

Keywords

• pulmonary embolism
• mortality
• risk stratification