The Utility of Modified Wells Score as a Pre-Test Risk Stratification Tool in Suspected Cases of Pulmonary Embolism Undergoing Computed Tomography Pulmonary Angiogram

Authors

  • Uzma Nisar Department of Radiology, Armed Forces Institute of Radiology & Imaging/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Hina Nasir Department of Radiology, Armed Forces Institute of Radiology & Imaging/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Zaha Iqbal Malik Department of Radiology, Armed Forces Institute of Radiology & Imaging/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Madiha Bangash Department of Radiology, Armed Forces Institute of Radiology & Imaging/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Zafar Amin Department of Radiology, Armed Forces Institute of Radiology & Imaging/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Abdur Rahim Palwa Department of Radiology, Armed Forces Institute of Radiology & Imaging/National University of Medical Sciences (NUMS) Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v73i5.5282

Keywords:

Computed tomography, Diagnostic yield, Modified Wells score, Pulmonary angiography, Pulmonary embolism

Abstract

Objectives: To assess the validity of pre-test evaluation of patients with Modified Wells score at our facility to improve
diagnostic yield of CT pulmonary angiography for pulmonary embolism.

Study Design: Prospective longitudinal study.

Place and Duration: Department of Computed Tomography, Armed Forces Institute of Radiology & Imaging, Pak Emirates
Military Hospital, Rawalpindi Pakistan, from Feb to Jul 2019.

Methodology: After approval from the Ethical Review Board, 60 patients with clinical suspicion of pulmonary embolism were selected. Modified Wells score was calculated for each patient, and a senior consultant reviewed their CT Pulmonary
Angiograms.

Results: Sixty patients were assessed from February to July 2019. Pulmonary embolism was diagnosed in 21(35%) patients;
22(37%) patients were unremarkable, while alternate diagnosis was provided for 17(28%) patients. Modified Wells score was
66.6% sensitive and 74.3% specific for diagnosis of pulmonary embolism, with a positive predictive value of 58.3% and a
negative predictive value of 80.5%.

Conclusion: Modified Wells score carries a good negative predictive value for ruling out pulmonary embolism. Hospitals
must devise their departmental protocol utilizing risk stratification tools, lab tests and other safer imaging alternatives, where applicable.

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Published

30-10-2023

Issue

Section

Original Articles

How to Cite

1.
Nisar U, Nasir H, Malik ZI, Bangash M, Amin Z, Palwa AR. The Utility of Modified Wells Score as a Pre-Test Risk Stratification Tool in Suspected Cases of Pulmonary Embolism Undergoing Computed Tomography Pulmonary Angiogram. Pak Armed Forces Med J [Internet]. 2023 Oct. 30 [cited 2024 Dec. 26];73(5):1275-8. Available from: https://pafmj.org/PAFMJ/article/view/5282