The Analysis Study of Comparison Clinical Scoring System in Pulmonary Embolism: A Comprehensive Systematic Review
Keywords:
clinical scoring system, pulmonary embolism, sensitivity, specificityAbstract
Background: Pulmonary embolism is a significant diagnostic challenge in emergency departments due to its life-threatening nature and non-specific symptoms. Diagnostic systems like CTPA have been developed to address these challenges, but their limitations and radiation exposure raise concerns about patient safety. Comparing clinical scoring systems for pulmonary embolism can enhance diagnosis yield and optimize resource allocation. Methods: This systematic review adhered to PRISMA 2020 guidelines, focusing exclusively on full-text articles published in English between 2014 and 2024. Editorials and review articles without a DOI were excluded to ensure the utilization of high-quality sources. A literature review was conducted utilizing reputable databases including ScienceDirect, PubMed, and SagePub to identify relevant studies. Result: The initial database search identified nearly 200 publications pertinent to the topic. After a thorough three-stage screening process, eight studies were chosen that satisfied the established inclusion criteria for detailed analysis. The studies underwent a thorough critical evaluation, facilitating a detailed examination of the comparison clinical scoring system in pulmonary embolism. This targeted methodology guaranteed that the analysis utilized robust evidence closely aligned with the study's aims. Conclusion: Pulmonary embolism diagnosis accuracy has been significantly improved by integrating clinical scoring systems with D-Dimer testing and PERC. Combinations like WS + PERC and RGS + PERC achieved near-perfect sensitivity, reducing failure rates. However, trade-offs exist between sensitivity and specificity, necessitating further research.
References
Giordano, N. J., Jansson, P. S., Young, M. N., Hagan, K. A., & Kabrhel, C. (2017). Epidemiology, Pathophysiology, Stratification, and Natural History of Pulmonary Embolism. Techniques in vascular and interventional radiology, 20(3), 135–140. https://doi.org/10.1053/j.tvir.2017.07.002
Morrone, D., & Morrone, V. (2018). Acute Pulmonary Embolism: Focus on the Clinical Picture. Korean circulation journal, 48(5), 365–381. https://doi.org/10.4070/kcj.2017.0314
Willich, S. N., Chuang, L. H., van Hout, B., Gumbs, P., Jimenez, D., Kroep, S., Bauersachs, R., Monreal, M., Agnelli, G., & Cohen, A. (2018). Pulmonary embolism in Europe - Burden of illness in relationship to healthcare resource utilization and return to work. Thrombosis research, 170, 181–191. https://doi.org/10.1016/j.thromres.2018.02.009
Anderson, D. R., Kahn, S. R., Rodger, M. A., Kovacs, M. J., Morris, T., Hirsch, A., Lang, E., Stiell, I., Kovacs, G., Dreyer, J., Dennie, C., Cartier, Y., Barnes, D., Burton, E., Pleasance, S., Skedgel, C., O'Rouke, K., & Wells, P. S. (2007). Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA, 298(23), 2743–2753. https://doi.org/10.1001/jama.298.23.2743
Chandra, S., Sarkar, P. K., Chandra, D., Ginsberg, N. E., & Cohen, R. I. (2013). Finding an alternative diagnosis does not justify increased use of CT-pulmonary angiography. BMC pulmonary medicine, 13, 9. https://doi.org/10.1186/1471-2466-13-9
Dalen, J. E., & Waterbrook, A. L. (2017). Why Are Nearly All CT Pulmonary Angiograms for Suspected Pulmonary Embolism Negative?. The American journal of medicine, 130(3), 247–248. https://doi.org/10.1016/j.amjmed.2016.03.043
Wolf, S. J., McCubbin, T. R., Feldhaus, K. M., Faragher, J. P., & Adcock, D. M. (2004). Prospective validation of Wells Criteria in the evaluation of patients with suspected pulmonary embolism. Annals of emergency medicine, 44(5), 503–510. https://doi.org/10.1016/j.annemergmed.2004.04.002
Kline, J. A., Courtney, D. M., Kabrhel, C., Moore, C. L., Smithline, H. A., Plewa, M. C., Richman, P. B., O'Neil, B. J., & Nordenholz, K. (2008). Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. Journal of thrombosis and haemostasis : JTH, 6(5), 772–780. https://doi.org/10.1111/j.1538-7836.2008.02944.x
Le Gal, G., Righini, M., Roy, P. M., Sanchez, O., Aujesky, D., Bounameaux, H., & Perrier, A. (2006). Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Annals of internal medicine, 144(3), 165–171. https://doi.org/10.7326/0003-4819-144-3-200602070-00004
Kabrhel, C., Van Hylckama Vlieg, A., Muzikanski, A., Singer, A., Fermann, G. J., Francis, S., Limkakeng, A., Chang, A. M., Giordano, N., & Parry, B. (2018). Multicenter Evaluation of the YEARS Criteria in Emergency Department Patients Evaluated for Pulmonary Embolism. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 25(9), 987–994. https://doi.org/10.1111/acem.13417
Guo, D. J., Zhao, C., Zou, Y. D., Huang, X. H., Hu, J. M., & Guo, L. (2015). Values of the Wells and revised Geneva scores combined with D-dimer in diagnosing elderly pulmonary embolism patients. Chinese medical journal, 128(8), 1052–1057. https://doi.org/10.4103/0366-6999.155085
Barnes, G. D., Muzikansky, A., Cameron, S., Giri, J., Heresi, G. A., Jaber, W., Wood, T., Todoran, T. M., Courtney, D. M., Tapson, V., & Kabrhel, C. (2020). Comparison of 4 acute pulmonary embolism mortality risk scores in patients evaluated by pulmonary embolism response teams. JAMA Network Open, 3(8), e2010779. https://doi.org/10.1001/jamanetworkopen.2020.10779
Coelho, J., Divernet-Queriaud, M., Roy, P. M., Penaloza, A., Le Gal, G., & Trinh-Duc, A. (2020). Comparison of the Wells score and the revised Geneva score as a tool to predict pulmonary embolism in outpatients over age 65. Thrombosis research, 196, 120–126. https://doi.org/10.1016/j.thromres.2020.07.026
Medson, K., Yu, J., Liwenborg, L., Lindholm, P., & Westerlund, E. (2022). Comparing 'clinical hunch' against clinical decision support systems (PERC rule, wells score, revised Geneva score and YEARS criteria) in the diagnosis of acute pulmonary embolism. BMC pulmonary medicine, 22(1), 432. https://doi.org/10.1186/s12890-022-02242-1
Gogulakrishnan, R., & Ramakrishnan, G. A. (2023). Comparison of various clinical scoring systems in assessing the probability of pulmonary thromboembolism in adults in a tertiary care hospital in South India. Journal of Association of Pulmonologist of Tamil Nadu, 6(2), 39–44. https://doi.org/10.4103/japt.japt_18_23
Tang, L., Hu, Y., Pan, D., Yang, C., Tang, C., Huang, Y., Gu, J., Min, M., Lin, X., & Tong, C. (2023). PECSS: Pulmonary Embolism Comprehensive Screening Score to safely rule out pulmonary embolism among suspected patients presenting to emergency department. BMC Pulmonary Medicine, 23(1). https://doi.org/10.1186/s12890-023-02580-8
Fayiad, H., Moussa, H., Nosair, Y., & Mostafa, A. I. (2024). Predictive accuracy of years score in diagnosis of pulmonary embolism. Egyptian Journal of Bronchology, 18(1). https://doi.org/10.1186/s43168-024-00269-y
Tang, L., Hu, Y., Min, M., Gu, J., Pan, D., Lin, X., & Tong, C. (2024). Comparisons of clinical scoring systems among suspected pulmonary embolism patients presenting to emergency department. Health science reports, 7(8), e70003. https://doi.org/10.1002/hsr2.70003
van Es, N., van der Hulle, T., van Es, J., den Exter, P. L., Douma, R. A., Goekoop, R. J., Mos, I. C., Galipienzo, J., Kamphuisen, P. W., Huisman, M. V., Klok, F. A., Büller, H. R., & Bossuyt, P. M. (2016). Wells Rule and d-Dimer Testing to Rule Out Pulmonary Embolism: A Systematic Review and Individual-Patient Data Meta-analysis. Annals of internal medicine, 165(4), 253–261. https://doi.org/10.7326/M16-0031
Stals, M. A. M., Takada, T., Kraaijpoel, N., van Es, N., Büller, H. R., Courtney, D. M., Freund, Y., Galipienzo, J., Le Gal, G., Ghanima, W., Huisman, M. V., Kline, J. A., Moons, K. G. M., Parpia, S., Perrier, A., Righini, M., Robert-Ebadi, H., Roy, P. M., van Smeden, M., Wells, P. S., … Klok, F. A. (2022). Safety and Efficiency of Diagnostic Strategies for Ruling Out Pulmonary Embolism in Clinically Relevant Patient Subgroups : A Systematic Review and Individual-Patient Data Meta-analysis. Annals of internal medicine, 175(2), 244–255. https://doi.org/10.7326/M21-2625
Bandos, A. I., Rockette, H. E., & Gur, D. (2010). Use of likelihood ratios for comparisons of binary diagnostic tests: underlying ROC curves. Medical physics, 37(11), 5821–5830. https://doi.org/10.1118/1.3503849
Naeger, D. M., Kohi, M. P., Webb, E. M., Phelps, A., Ordovas, K. G., & Newman, T. B. (2013). Correctly using sensitivity, specificity, and predictive values in clinical practice: how to avoid three common pitfalls. AJR. American journal of roentgenology, 200(6), W566–W570. https://doi.org/10.2214/AJR.12.9888
Çorbacıoğlu, Ş. K., & Aksel, G. (2023). Receiver operating characteristic curve analysis in diagnostic accuracy studies: A guide to interpreting the area under the curve value. Turkish journal of emergency medicine, 23(4), 195–198. https://doi.org/10.4103/tjem.tjem_182_23
Sundbøll, J., Adelborg, K., Munch, T., Frøslev, T., Sørensen, H. T., Bøtker, H. E., & Schmidt, M. (2016). Positive predictive value of cardiovascular diagnoses in the Danish National Patient Registry: a validation study. BMJ open, 6(11), e012832. https://doi.org/10.1136/bmjopen-2016-012832
Öhman, L., Johansson, M., Jansson, J. H., Lind, M., & Johansson, L. (2018). Positive predictive value and misclassification of diagnosis of pulmonary embolism and deep vein thrombosis in Swedish patient registries. Clinical epidemiology, 10, 1215–1221. https://doi.org/10.2147/CLEP.S177058
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Meirisa, Stevany Nurifin, Mely Christina Damanik (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors publishing here keep copyright but grant the journal first publication rights, under a Creative Commons Attribution-NonCommercial 4.0 License. They can distribute their work non-exclusively elsewhere with an acknowledgment of its first publication in this journal. Posting the work online before and during submission for earlier and greater citation is encouraged, reflecting Open Access benefits.
