TY - JOUR T1 - Performance of the revised Geneva score in patients with a delayed suspicion of pulmonary embolism JF - European Respiratory Journal JO - Eur Respir J SP - 1801 LP - 1804 DO - 10.1183/09031936.00214113 VL - 43 IS - 6 AU - Paul L. den Exter AU - Pim van den Hoven AU - Tom van der Hulle AU - Inge C.M. Mos AU - Renée A. Douma AU - Josien van Es AU - Menno V. Huisman AU - Frederikus A. Klok Y1 - 2014/06/01 UR - http://erj.ersjournals.com/content/43/6/1801.abstract N2 - To the Editor:Establishing a prompt diagnosis of acute pulmonary embolism is a diagnostic challenge, as the clinical presentation ranges from haemodynamic shock to very subtle symptoms mimicking those of other cardiovascular or pulmonary diseases [1]. This diverse presentation facilitates diagnostic delay and, consequently, also a delay in treatment initiation, which might be an important prognostic indicator for patients with acute pulmonary embolism [1]. The standard diagnostic algorithm for suspected acute pulmonary embolism consists of sequential pre-test probability determination, D-dimer testing and computed tomography pulmonary angiography (CTPA) [2]. The pre-test probability can be estimated using a validated clinical decision rule (CDR), such as the Wells score and the revised Geneva score (RGS) [3, 4]. In addition to an excellent sensitivity and specificity, the main advantage of this diagnostic algorithm is that 20–30% of all patients with a clinical suspicion can be managed without CTPA, since an unlikely clinical probability in combination with a normal high-sensitive D-dimer test result has been shown to accurately rule out acute symptomatic pulmonary embolism [5]. The significance of the appropriate use of this diagnostic management strategy in patients with suspected pulmonary embolism has been highlighted by a prospective cohort study [6]. In patients with inappropriate diagnostic management, the diagnostic failure rate was 7.7%, compared to 1.2% for those patients in whom pulmonary embolism was ruled out according to the strategy (p<0.001). Importantly, symptoms suggestive of pulmonary embolism that could also be ascribed to underlying cardiopulmonary diseases (e.g. heart failure or chronic lung disease) were identified as an important factor … ER -