Which is more valuable in the diagnosis of pulmonary thromboembolism? The wells score, the revised geneva score, or the padua score?

Abstract

Background: Pulmonary thromboembolism (PTE) is a preventable yet potentially fatal condition with significant morbidity and mortality. Several clinical scoring systems, including the Wells and modified Geneva scores, have been developed to assess the likelihood of PTE and guide further diagnostic evaluation. The Padua prediction score, primarily used to assess venous thromboembolism (VTE) risk in hospitalized patients, has also been considered for its potential utility in suspected PTE cases. Methods: This retrospective study included 257 patients with suspected acute PTE. Diagnosis was confirmed by computed tomography pulmonary angiography (CTPA) in 140 patients (patient group), while 117 patients without radiologic evidence of PTE served as controls. All participants were evaluated using Wells, modified Geneva, and Padua scores. Sensitivity, specificity, predictive values, and the effect of combining scores with age-adjusted D-dimer levels were analyzed. Results: The Wells score demonstrated a sensitivity of 60% and specificity of 91%, with a positive predictive value of 88%. Modified Geneva and Padua scores showed lower diagnostic accuracy. Negative predictive values increased significantly when combined with age adjusted D-dimer levels. Conclusions: The Wells score was the most reliable tool among the three for predicting PTE. Combining clinical scoring with D-dimer testing enhances diagnostic accuracy and may reduce unnecessary imaging in patients with low to moderate risk.