Tillie-Leblond et al identified risk factors associated with a pulmonary embolism that causes an unexplained exacerbation of chronic obstructive pulmonary disease (COPD). Any patient with an unexplained exacerbation for COPD should be evaluated for pulmonary embolism. The authors are from University Hospital A Calmette in Lille, France.
Patient selection: unexplained exacerbation of COPD
Parameters:
(1) history of previous thromboembolic disease
(2) history of malignant disease
(3) change in PaCO2
decrease in PaCO2 after the onset =
= (PaCO2 before onset in mm Hg) - (PaCO2 after onset in mm Hg)
|
Parameter
|
Finding
|
Points
|
|
history of previous thromboembolic disease
|
none
|
0
|
|
|
present
|
1
|
|
history of malignant disease
|
none
|
0
|
|
|
present
|
1
|
|
change in PaCO2
|
decrease in PaCO2 < 5 mm Hg
|
0
|
|
|
decrease in PaCO2 >= 5 mm Hg
|
1
|
number of risk factors for PE =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
• The higher the score the greater the probability of a pulmonary embolism.
The authors showed that the modified Geneva score (which used history of malignancy in place of recent surgery) was effective in identifying patients with a PE.
NOTE: This score could easily be expanded to include:
(1) signs of deep vein thrombosis (swollen calves, positive Doppler, etc.)
(2) post-operative state, bed rest or other risk factors for deep vein thrombosis
(3) discontinuation or interruption in anticoagulation therapy
(4) other hypercoagulable state (in addition to the history of malignancy)
Some of these factors are listed in Table 3 on page 393, but the numbers were small.
