Gülfer OKUMUŞ, Halim İŞSEVER, Levent TABAK, Esen KIYAN, Orhan ARSEVEN, Engin Rabia ÜNVER

Comparison of three clinical scoring methods in patients with pulmonary thromboembolism

Pulmoner tromboemboli (PTE)’de en sık görülen semptomların nonspesifik olması nedeniyle klinik tanı güvenilir değildir. Klinik olasılık değerlendirmesi için günümüzde değişik skorlama yöntemleri mevcuttur. Bu çalışmanın amacı; PTE’si kanıtlanmış olgularda Wells, Wicki ve modifiye Hyer skorlamalarına göre elde edilen klinik olasılıkları karşılaştırarak aralarındaki korelasyonu araştırmaktır. Bu amaçla kliniğimizde PTE tanısı alan olguların klinik olasılıkları Wells, Wicki ve modifiye Hyer yöntemleri ile ayrı ayrı belirlendi. Üç yöntemin uyum katsayıları; cramer, kontenjan katsayısı (CC), Kendal’ın tau-b ve kappa testleri ile, sıra katsayıları ise Spearman’ın rho testi ile hesaplandı. Çalışmaya alınan 248 olgunun 119’ u erkek, 129’u kadın ve ortalama yaşları 57 ± 16.7 idi. Modifiye Hyer yöntemine göre olguların %61.3’ü yüksek klinik olasılık olarak tanımlanırken, Wicki’ye göre %56, Wells’e göre %50 olgu orta klinik olasılıklı olarak tanımlanmıştı. Çalışmamızda klinik olasılığı skorlayan üç yöntem karşılaştırıldı. Bu yöntemler arasındaki korelasyon; kappa uyum katsayısına göre zayıf, diğer katsayılara göre istatistiksel olarak orta güçte bulundu. Gruplar arasında en güçlü korelasyon modifiye Hyer yöntemi ile Wells yöntemi arasında bulunmuştur.

Pulmoner tromboemboli tanısı alan olgularda üç farklı klinik skorlama yönteminin karşılaştırılması

The clinical diagnosis is not reliable in pulmonary thromboembolism (PTE) because the symptoms are mostly nonspecific. Different clinical prediction rules for PTE have been described recently. These rules are used to aid clinicians in assigning a pre-test probability to patients with clinical signs and symptoms of disease. The aim of this study was to assess the clinical probability of PTE using three different models (Wells, Wicki and modified Hyers scores) and to find their power to determine PTE probability. Clinical probabilities of patients with PTE were determined with Wells, Wicki and modified Hyers scores. Cramer’s, contingency coefficient (CC), Spearman’s rho, Kendal’s tau-b and kappa tests were used for statistical analysis. The study included 248 patients (119 male, 129 female; mean age= 57 ± 16.7 years). Although 61.3% of the patients were assigned high clinical probability with modified Hyers score, 56% and 50% of them were assigned moderate clinical probability with Wicki and Wells scores, respectively. The correlations of the clinical probabilities was low according to kappa correlation test and moderate according to the Cramer’s, CC, Spearman’s rho and Kendal’s tau-b tests among these three scores. In conclusion, modified Hyers score showed higher percentage of high probability compared to Wells and Wicki scoring systems and the best correlation was found between the modified Hyers and Wells scores.

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