Wells ve PERC skorlarının bir göğüs hastalıkları hastanesi acil servisinde pulmoner emboliyi dışlamada etkinliği

Year 2020, , 12 - 17, 21.03.2020

Pınar Akın Kabalak , Tuğba Çiçek Ömer Faruk Çiçek , Derya Kızılgöz Ülkü Yılmaz

https://doi.org/10.18663/tjcl.532339

Abstract

Amaç: Pulmoner emboli dışlama kriteri, emboli tanısını dışlamada kullanılan bir tanısal algoritmadır. Rutin pratiğimizde sıklıkla kullanılmasa da düşük klinik riske sahip hastalarda mevcut diğer algoritmalara göre daha iyi bir negative prediktif değere sahiptir. Bir göğüs hastalıkları acil servisinde PERC ve Wells skorunu birlikte değerlendirmeyi amaçladık.

Gereç ve Yöntemler: Hastane kayıt sistemi kullanılarak retsopektif olarak incelenen 163 hasta dahil edildi. Olguların hepsinde pulmoner emboli şüphesi ile görüntüleme yöntemi kullanılmıştı. PERC pozitif ve negatif olan her iki grupta emboli prevelansı hesaplandı. Ayrıc PERC skorunun her bir parametresi pulmoner emboli için risk olması açısından ayrı ayrı ele alındı.

Bulgular: Emboli tanısı alan olgularda PERC pozitiflik oranı % 82.4 saptandı. Pulmoner emboli olan ve olmayan gruplar arasında PERC pozitifliği açısından fark saptanmadı (p=0.336). Wells skoru orta-yüksek olan grupta yalancı pozitiflik oranı %36.1’di. Emboli tanısı alan grupta PERC negatiflik oranı %36.1 iken emboli saptanmayan grupta bu oran %17.6’ydı (p=0.75 and r=-0.025). PERC skor sensitivitesi %82.3, spesifitesi %19.6, PPV %63.1, NPV %40, yanlış pozitiflik oranı %36.8 ve yanlış negatiflik oranı %60 saptandı. Wells skoru orta-yüksek olan grupta 61 hastada emboli tanısı koyuldu ve bu hastaların 14’ünde PERC negatifti.

Sonuç: Çalışma sonuçlarımızdan yola çıkarak, Wells skoru ile birlikte ele alınsa bile PERC skoru emboli tanı sürecinde gereksiz görüntülemeyi azaltma konusunda yeterli etkinlikte görülmemiştir.

Keywords

Wells, PERC, Pulmoner embolizm

Efficiacy of Wells score and Pulmonary Embolism Rule Out Criteria(PERC) to exclude pulmonary embolism in a pulmonary emergency ward

Abstract

Aim: The Pulmonary Embolism Rule-out Criteria (PERC) rule is a diagnostic algorithm to exclude pulmonary embolism (PE). Even it is not widely used in routine practice, has better negative predictive value in low-risk populations among existed clinical assessment tests. We aimed to examine availability of PERC rules combined with Wells score in a pulmonary emergency ward.

Material and Methods: A retrospective hospitalized database study was conducted with 163 patients. All patients who underwent radiological investigation due to suspicious for PE were included. We calculated prevalence of PE in group of PERC negative and PERC positive. All PERC parameters were evaluated solely for risk of PE.

Results: PERC positivity was 82.4% in patients diagnosed with PE. There were no significant differences in terms of PERC positivity between PE+ and PE- groups (p=0.336). False positivity rate for moderate to high Wells score was 36.1%. Frequency of PERC negativity among PE negative patients was only %36.1 and %17.6 in PE positive group (p=0.75 and r=-0.025). The sensitivity of the PERC test was 82.3%, specificity 19.6%, PPV 63.1%, NPV 40%, false positivity rate 36.8% and false negativity rate 60%. Among patients with moderate to high wells, 61 patients were diagnosed PE and 14 of them were PERC negative.

Conclusion: Our study suggests that PERC scoring system even combined with Wells score does not sufficient enough to prevent unnecessary irradiative imaging studies in a pulmonary emergency ward.

Keywords

Wells, PERC, pulmonary embolism

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