Validity of Pulmonary Embolism Prediction Scores in Pregnant, Postpartum Women

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The Wells and revised Geneva scores are not reliable tools for predicting PE in pregnant or postpartum women.
The Wells and revised Geneva scores are not reliable tools for predicting PE in pregnant or postpartum women.

The Wells and the revised Geneva scores may not be valid or reliable tools for predicting the presence of a pulmonary embolism (PE) in pregnant or postpartum women, according to a study published in the European Journal of Obstetrics and Gynecology and Reproductive Biology.

Researchers identified 103 women who were either pregnant or postpartum admitted to the emergency department at the Tunis Maternity and Neonatology Center in Tunisia with a suspected PE during a 3-year period. The medical records of these women were retrospectively analyzed, and both a Wells score and Geneva score were calculated for each woman. The purpose of the study was to determine the accuracy of both scores in predicting the low, medium, or high probability of the presence of an embolism.

 

Overall, 27 of the 103 women (26.2%) were diagnosed with a PE.  The low, medium, and high probability scores of the women using the Wells score were 75.7%, 22.3%, and 1.9%, respectively. However, the percentage of women actually diagnosed with a PE in each category was 20.5%, 43.5%, and 50%, respectively. The percentage of women in the low, medium, and high categories scored using the revised Geneva score were found to be 51.5%, 45.6% and 2.9%, respectively, with the percentage of women actually diagnosed with a PE being 17%, 36.2%, and 33.3%, respectively.

No statistical significant difference was found between the Wells score and the revised Geneva score regarding the prevalence of a PE in both low-risk groups (20.5% and 17.5%, respectively, P =.232). Approximately 25% (n=26) of women were classified into different groups with scores from both tools, with a k coefficient of 0.154 for agreement between the two scores. Finally, the sensitivity, specificity, positive predictive value, and negative predictive value of the Wells score were 40.7%, 81.5%, 44%, and 79.4%, respectively, while the same measurements using the Geneva Score were 62.9%, 59.2%, 35.4% and 81.8%, respectively.

The researchers concluded that the Wells score and revised Geneva score were not valid or reliable tools for predicting the presence of a PE in a pregnant or postpartum woman. Therefore, clinicians should not use either of these tools in pregnant or postpartum women to assess the probability of a PE diagnosis as neither could accurately rule out a PE in women placed in low-risk groups.

“A specific risk score of PE for [the] pregnant and postpartum population is needed to reduce the rate of unnecessary imaging studies, especially in this specific population where the use of radiation and contrast agent is problematic,” the researchers concluded.

Reference

Touhami O, Marzouk SB, Bennasr L, et al. Are the Wells score and the revised Geneva score valuable for the diagnosis of pulmonary embolism in pregnancy? Eur J Obstet Gynecol Reprod Biol. 2018;221:166-171.

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