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A Simple Score

Jacques Wicki, MD; Thomas V. Perneger, MD, PhD; Alain F. Junod, MD; Henri Bounameaux, MD; Arnaud Perrier, MD

Arch Intern Med. 2001;161:92-97.

Objective  To develop a simple standardized clinical score to stratify emergency ward patients with clinically suspected pulmonary embolism (PE) into groups with a high, intermediate, or low probability of PE to improve and simplify the diagnostic approach.

Methods  Analysis of a database of 1090 consecutive patients admitted to the emergency ward for suspected PE in whom diagnosis of PE was ruled in or out by a standard diagnostic algorithm. Logistic regression was used to predict clinical parameters associated with PE.

Results  A total of 296 (27%) of 1090 patients were found to have PE. The optimal estimate of clinical probability was based on 8 variables: recent surgery, previous thromboembolic event, older age, hypocapnia, hypoxemia, tachycardia, band atelectasis, or elevation of a hemidiaphragm on chest x-ray film. A probability score was calculated by adding points assigned to these variables. A cutoff score of 4 best identified patients with low probability of PE. A total of 486 patients (49%) had a low clinical probability of PE (score 4), of which 50 (10.3%) had a proven PE. The prevalence of PE was 38% in the 437 patients with an intermediate probability (score of 5-8; n = 437) and 81% in the 63 patients with a high probability (score 9).

Conclusions  This clinical score, based on easily available and objective variables, provides a standardized assessment of the clinical probability of PE. Applying this score to emergency ward patients suspected of having PE could allow a more effective diagnostic process.

From the Medical Clinic 1 (Drs Wicki, Junod, and Perrier), Quality of Care Unit and Institute of Social and Preventive Medicine (Dr Perneger), and Division of Angiology and Hemostasis (Dr Bounameaux), Geneva University Hospital, Geneva, Switzerland.

Corresponding author and reprints: Arnaud Perrier, MD, Medical Clinic 1, Department of Internal Medicine, Geneva University Hospital, 24 Rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland (e-mail: Arnaud.Perrier{at}medecine.unige.ch).

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