Wells与修正Geneva评分急诊筛肺栓塞的比较查  

Comparison of the screening effects between Wells and revised Geneva scores on suspected acute pulmonary thromboembolism

作　　者：吴伟程[1] 蔺际龚[1] 杨成彬[1] 吴郁珍[1] 俞祥玫[1] 刘加权[1] 张自立[1] 

机构地区：[1]厦门大学附属第一医阮急诊部,361003

出　　处：《中华急诊医学杂志》2012年第3期282-285,共4页Chinese Journal of Emergency Medicine

基　　金：厦门市社会发展科技计划项目（3502Z20114006）

摘　　要：目的比较Wells与修正Geneva评分筛查急性肺栓塞（acute pulmonary thromboembolism，APTE）效果，寻找适合我国急诊科诊断APTE的策略。方法对厦门大学附属第一医院急诊部诊治的167例疑似APTE患者采用随机、交叉、前瞻性研究，先后进行Wells和修正Geneva评分，比较它们的筛查效果。结果Wells和修正Geneva评分诊断APTE的受试者工作特征曲线下面积分别为（0．917±0．022）和（0．927±0．020），差异具有统计学意义（P〈0．05）；两者诊断APTE的一致性较差（kappa=0．276），分层判别之间的差异具有统计学意义（P〈0．05）；相比较而言，Wells评分判断APTE低度可能的例数少，中、高度可能的例数多。两种评分方法判断为低度可能者全部排除了APTE；中度可能的病例中，Wells评分诊断准确率（9．64％）明显低于修正Geneva评分（32．84％），差异具有统计学意义（P〈0．05）；判断为高度可能的病例中，Wells评分诊断准确率（67．24％）与修正Geneva评分（86．21％）的差异无统计学意义（P=0，059）。结论修正Geneva评分比Wells评分更适宜在我国急诊科筛查可疑APTE患者。Objective To compare the screening effects between Wells and revised Geneva scores on suspected acute pulmonary thromboembolism （APTE）, and to explore a optimum screening method for APTE in the emergency department of China. Methods The study was carried out by using random, crossed, prospective methods to compare the screening effects between Wells and revised Geneva scores for 167 suspected APTE patients in the emergency department of the First Affiliated Hospital of Xiamen University. Results The areas under the receiver operating characteristic curve of Wells and revised Geneva scores for screening APTE in the emergency department were （0. 917 ＋ 0. 022 ） and （ 0. 927 ＋ 0. 020）, respectively （ P 〈 0. 05 ）. The diagnostic concordance between the two score systems for predicting APTE was poor （Kappa value = 0. 276 ）. In addition, the difference between their hierarchical discrimination for the possibility of APTE was statistically significant （ P 〈 0. 05 ）. Compared with revised Geneva score, fewer patients were diagnosed with low clinical probability of APTE and more patients were diagnosed with intermediate or high clinical probability of APTE through Wells score. The patients with low clinical probability of APTE were excluded from pulmonary embolism in Wells or revised Geneva score. At intermediate clinical probability, the accuracy rate of Wells score for predicting APTE （9. 64% ） was lower than that （32. 84% ） of revised Geneva （ P 〈 0. 05）. At high clinical probability, there was no significant difference between their accuracy rate [ （67.24% vs. 86.21%）, P〉0.05]. Conclusions Revised Geneva score is more suitable than Wells score in screening suspected APTE patients in the emergency department in our country

关 键 词：急性肺栓塞 筛查 WELLS评分 修正Geneva评分 

分 类 号：R563.5[医药卫生—呼吸系统]