A combination of the Wells score with multiorgan ultrasound to stratify patients with suspected pulmonary embolism

Introduction: The pre-test probability of pulmonary embolism (PE) is conventionally estimated by the clinical Wells score (WS). Several studies have considered the role of lung, heart and peripheral veins ultrasound in the diagnosis of PE. Aims and Objectives: The purpose of this multicenter study was to evaluate whether the combination of the WS with multiorgan ultrasound (MUS) performs better than the conventional criteria based on the sole WS. Methods: In consecutive patients with suspected PE we calculated the WS and performed MUS. We subsequently integrated the WS with the MUS diagnosis of deep venous thrombosis and the probability of an alternative diagnosis based on the lung examination. The final diagnosis was confirmed on computerized tomography and/or clinical follow-up at 30 days. Accuracy of WS alone and WS/MUS in the prediction of PE, were statistically compared. Results: We enrolled 249 patients, including 60 (24.1%) with a confirmed diagnosis of PE. The WS was >4 in 106 patients of which 35 (33%) had PE. In 143 patients with Wells score ≤4, 25 patients (17.5%) had EP. The MUS was performed in 7 ± 3 minutes. The WS-MUS was >4 in 62 patients of which 42 (67.7%) with PE, while in 187 patients with WS-MUS ≤4, only 18 cases (9.6%) had PE. A WS-MUS >4 showed sensitivity 70% and specificity 89.4%, significantly higher than the traditional WS (sensitivity 58.3% and specificity 62.4%). The area under the curve of WS-US (88.4%) was significantly superior to WS (62.1%, p<0.01). Conclusions: The integration of the WS with a bedside MUS examination improves the accuracy of the conventional WS for the pre-test stratification of PE likelihood.