Pregnancy-Adapted Geneva Score – Pre-test Probability of Acute PE in Pregnancy

Why does this matter?
Available clinical decision tools (CDTs) for PE have not been derived or validated on a large-scale basis in pregnant patients (1). Two CDTs: the Geneva Score (CT-PE pregnancy study) and pregnancy-adapted YEARS algorithm (ARTEMIS study) and have been used in combination with D-dimer as diagnostic strategies to assess pre-test probability of acute PE in pregnancy (2-4). Although, more limited studies (5,6) have suggested clinical equipoise in their use (7), these CDTs should be considered in pregnant patients with suspected PE.

PE in pregnancy: better tools on the horizon?
This work derived a pregnancy-specific Geneva Score from the CT-PE pregnancy cohort (2) and compared the diagnostic accuracy of this derived score to the Geneva Score used in the original cohort. Data from the multicenter, prospective management outcome study group included 395 women with suspected PE. Geneva Score criteria for age and heart rate were modified in the pregnancy-adapted score and clinical weighting for active malignancy was removed (see table). Scores can range from 0-20; low is 0-1, intermediate 2-6, and high ≥7. The area under the curve (AUC) for the receiver operating characteristic (ROC) was 0.795 (95%CI 0.690-0.899) for the pregnancy-adapted compared to 0.684 (95%CI 0.563-0.805). Although the pregnancy-adapted Geneva Score shows promising discriminative power, it will need to be tested in a prospective study before it is ready for prime time.

Another Spoonful

1. Refresher on ROC analyses

2. EM Ottawa blog discusses diagnostic dilemmas for PE in pregnancy

3. Rebel EM blog discusses DiPEP Study

Source
Assessing the clinical probability of pulmonary embolism during pregnancy: The Pregnancy-Adapted Geneva (PAG) score. J Thromb Haemost. 2021 Sep 8. doi: 10.1111/jth.15521.