Diagnostic Accuracy of D-Dimer Testing and the Revised Geneva Score in the Prediction of Pulmonary Embolism
Received 3 November 2020
Accepted for publication 27 November 2020
Published 15 December 2020 Volume 2020:13 Pages 1537—1543
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Scott Fraser
Mostafa A Abolfotouh,1– 3 Khaled Almadani,3 Mohammed A Al Rowaily2,3
1King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 2King Saud Bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
Correspondence: Mostafa A Abolfotouh
Research Center (Mail Code 3533), King Saud Bin-Abdulaziz University for Health Sciences (KSAU-HS), King Abdulaziz Medical City, National Guard Health Affairs, POB 22490, Riyadh 11426, Saudi Arabia
Background: Pulmonary embolism (PE) diagnosis can sometimes be challenging due to the disease having nonspecific signs and symptoms at the time of presentation. The present study aimed to evaluate the validity of the D-dimer in combination with the revised Geneva score (RGS) in the prediction of pulmonary embolism.
Patients and Methods: This is a retrospective study of 2010 patients with suspected PE who had undergone both D-dimer testing followed by chest CT angiography (CTPA), irrespective of the D-dimer test results, at King Abdulaziz Medical City, Riyadh, Saudi Arabia, over 3 years, from Jan. 2016 to Jan. 2019. The predictive accuracy of D-dimer, adjusted D-dimer, and RGS was calculated. The receiver operating characteristic “ROC” curve was applied to allocate the optimum RGS cutoff for PE prediction.
Results: The overall prevalence of PE was 16%. It was 0%, 25.8%, and 88.9% in low, intermediate, and high clinical probability categories of RGS, respectively. Both conventional and age-adjusted D-dimer thresholds showed significant level of agreement (kappa=0.81, p< 0.001), high sensitivity (94% and 92.8%), high negative predictive value “NPV” (91.2% and 91.4%), low specificity (12.3% and 15.3%), and low positive predictive value “PPV” (17.5% and 17.8%), respectively. Combination of the age-adjusted D-dimer threshold and RGS at a cut-off of 5 points would provide 100% sensitivity and 61.7% specificity 34.1% PPV, 100% NPV, and 0.87 area under the curve “AUC”. At an RGS cutoff < 5 points, PE could have been ruled out in more than one-half (1036, 51.5%) of all suspected cases, and would have saved the cost of CTPA.
Conclusion: Conventional and age-adjusted D-dimer tests showed high levels of agreement in the prediction of PE, high sensitivity, and low specificity. RGS has a good performance in PE prediction. Using the revised Geneva score alone rules out PE for more than one-half of all suspected without further imaging.
Keywords: validity, sensitivity, specificity, deep vein thrombosis, agreement, clinical probability, D-dimer, age-adjusted threshold, CTPA
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