PE – Simplified Wells and Age-Adjusted Dimer

March 1, 2017

Short Attention Span Summary

Keep it simple
I am a big fan of the simplified Wells score for PE.  It uses 1 or 0 and provides a dichotomous result: PE likely or PE unlikely.  And it is as good as the complex version.  This study looked at the performance of the original vs. simplified Wells score for PE and age-adjusted D-dimer and found they were the same.  Specifically, the failure rate to detect PE was 0.9% with the original + age-adjusted dimer vs 0.8% with the simplified + age-adjusted dimer.  If the simplified version is easier to use, provides a dichotomous result, and is as good as the original, why not keep it simple?

Spoon Feed
You can choose either the original Wells or simplified Wells score with an age-adjusted D-dimer to exclude PE.  Personally, I prefer the simpler version.  Hey @mdcalc, when are you going to add the simplified Wells?

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Abstract

J Thromb Haemost. 2017 Jan 20. doi: 10.1111/jth.13630. [Epub ahead of print]

The original and simplified Wells rules and age-adjusted D-dimer testing to rule out pulmonary embolism: an individual patient data meta-analysis.

van Es N1, Kraaijpoel N1, Klok FA2, Huisman MV2, Den Exter PL2, Mos IC2, Galipienzo J3, Büller HR1, Bossuyt PM4.

Author information:

1Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.

2Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands.

3Service of Anesthesiology, Hospital MD Anderson Cancer Center, Madrid, Spain.

4Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands.

Abstract

BACKGROUND:

The Wells score and D-dimer testing can safely rule out pulmonary embolism (PE). A simplification of the Wells score has been proposed to improve clinical applicability, but evidence on its performance is scarce.

OBJECTIVES:

To compare the performance of the original and simplified Wells scores alone and in combination with age-adjusted D-dimer testing.

METHODS:

Individual patient data from 7,268 patients with suspected PE enrolled in 6 management studies were used to evaluate the discriminatory performance of the original and simplified Wells scores. The efficiency and failure rate of the dichotomized original and simplified scores combined with age-adjusted D-dimer testing were compared using a one-stage random effects meta-analysis. Efficiency was defined as the proportion of patients in whom PE could be considered excluded based on a ‘PE unlikely’ Wells score and a negative age-adjusted D-dimer. Failure rate was defined as the proportion of patients with symptomatic venous thromboembolism during 3-month follow-up.

RESULTS:

The discriminatory performance of the original and simplified Wells scores was comparable (c-statistic 0.73 [95% CI 0.72-0.75] vs. 0.72 [95% CI 0.70-0.73]). When combined with age-adjusted D-dimer testing, the original and simplified Wells rules had comparable efficiency (33% [95% CI 25-42%] vs 30% [95% CI 21-40%]) and failure rates (0.9% [95% CI 0.6-1.5%] vs. 0.8% [95% CI 0.5-1.3%]).

CONCLUSION:

The original and simplified Wells rules combined with age-adjusted D-dimer testing have similar performance in ruling out pulmonary embolism. Given its ease of use in clinical practice, the simplified Wells rule is to be preferred. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

PMID: 28106338 [PubMed – as supplied by publisher]