Tang et al reported the Pulmonary Embolism Comprehensive Screening Score (PECSS) which can be used in conjunction with the plasma D-dimer to exclude pulmonary embolism. The authors are from Fudan University in Shanghai.
Patient selection: suspected pulmonary embolism
Parameters (items 8 to 14 are the Wells score):
(1) anhelation (panting or shortness of breath causing breathing difficulty)
(2) blood pressure
(3) serum pro-BNP in pg/mL
(4) serum CRP in mg/L
(5) serum uric acid in µmol/L
(6) clinical condition on admission
(7) age in years
(8) venous thromboembolism (VTE) symptoms
(9) alternative diagnosis
(10) heart rate in beats per minute
(11) immobilization or surgery
(12) history of previous pulmonary embolism or venous thromboembolism
(13) hemoptysis
(14) active cancer
|
Parameter
|
Finding
|
Points
|
|
anhelation
|
no
|
0
|
|
|
yes
|
1.5
|
|
blood pressure
|
normal
|
0
|
|
|
abnormal
|
1
|
|
serum pro-BNP
|
<= 1,000 pg/mL
|
0
|
|
|
> 1,000 pg/mL
|
0.5
|
|
serum CRP
|
<= 30 mg/L
|
0
|
|
|
> 30 mg/L
|
0.5
|
|
serum uric acid
|
<= 300 µmol/L
|
0
|
|
|
> 300 µmol/L
|
0.5
|
|
clinical condition
|
critical
|
0.5
|
|
|
other
|
0
|
|
age in years
|
<= 65 years
|
0
|
|
|
> 65 years
|
0.5
|
|
VTE symptoms
|
no
|
0
|
|
|
yes
|
3
|
|
alternative diagnosis
|
no
|
3
|
|
|
yes
|
0
|
|
heart rate
|
<= 100 beats per minute
|
0
|
|
|
> 100 beats per minute
|
1.5
|
|
immobilization or surgery
|
no
|
0
|
|
|
yes
|
1.5
|
|
previous PE or VTE
|
no
|
0
|
|
|
yes
|
1.5
|
|
hemoptysis
|
no
|
0
|
|
|
yes
|
1
|
|
active cancer
|
no
|
0
|
|
|
yes
|
1
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 17.5
• A score < 4 is considered safe (PE ruled out) and exempt from CT pulmonary angiography (CTPA).
• A score <= 6 with a d-dimer <= 2.5 mg/L is considered safe and exempt from CTPA.
Performance:
• The sensitivity is 0.98 and specificity 0.52.
