Investigating The Prognostic Significance Of Simplified Wells And Geneva Characteristics In Ascertaining Hospital Mortality (Prognostic Factor) In Patients With Acute Pulmonary Embolism

Background: Pulmonary embolism is considered to be one of the most prevalent causes of death that can be prevented in patients who are hospitalized. By implementing appropriate measures of treatment, it is possible to significantly diminish the mortality rate. Various clinical diagnostic protocols have been introduced to ascertain the presence of acute pulmonary embolism, including the Geneva scoring system, PERC criteria, PISAPED criteria, and the Wells scoring system. Nevertheless, no definitive evidence has been provided to substantiate the supremacy of any one of these methods over the others. In pursuit of this, the present investigation aimed to determine the predictive worth of the simplified Wells and Geneva criteria in establishing the mortality rate within the hospital setting, specifically focusing on patients with acute pulmonary embolism and normal blood pressure. Method: This particular cohort study conducted in the year ۲۰۱۷ encompassed a group of ۱۳۳ individuals above the age of ۱۸ who were deemed suitable candidates for a diagnostic examination regarding acute pulmonary embolism. The selection criteria for these patients involved a combination of clinical diagnostic criteria, laboratory criteria (specifically D dimer), and imaging techniques (such as color Doppler ultrasound and CT angiography of the lung). Only those patients who were diagnosed with acute pulmonary embolism based on the evaluation of CT angiography results by a proficient radiologist were included in the study. The progress of all patients was subsequently monitored for a period of ۳۰ days. During the follow-up of the patients, the main outcome that was examined was the mortality of the patient. The follow-up process was conducted either through phone contact or, in cases of re-hospitalization, by reviewing the patient's file. Pertinent demographic details such as age, gender, and symptoms observed during the visit were documented in the checklist. Subsequently, the patients' score was calculated based on the simplified Geneva and WELLS criteria, utilizing the information from the patient's file or through a revaluation of their medical history by a trained researcher. Results: The mean scores of Wells and Geneva in the examined individuals were ۵.۰۲ ± ۲.۳ and ۳.۱۳ ± ۱.۲, correspondingly. ۳۴.۶% of patients with pulmonary thromboembolism necessitated re-hospitalization. ۲۶.۳% of patients expired with the primary diagnosis of pulmonary thromboembolism, and one decease was unrelated to embolism. Based on the conclusive outcome, the mean scores of Wells and Geneva indicated a statistically significant disparity in the mean scores of patients based on the requirement for re-hospitalization (P=۰.۰۰۱). The average Wells score of patients, considering their mortality, exhibited a statistically notable variation (P=۰.۰۰۱). The analysis of regression unveiled that mortality was associated with demographic factors as well as Wells and Geneva scores. Notably, increases in the Wells score (every ۰.۲۲۹ score increase) are independently and positively correlated with an elevation in mortality. Conclusion: The findings of the current investigation have revealed that the Wells criteria possess the capability to ascertain the prognosis of patients with a reasonably elevated level of precision. The principal merit of the present study, as opposed to prior investigations, lies in its capacity to establish the cut off for the Wells and Geneva criteria.

Keywords:

Geneva Score , Wells Score , Pulmonary embolism , Mortality.