Wells Rule Beats 'Gestalt' in Ruling Out Pulmonary Embolism

This article originally appeared here.
Share this content:
Wells Rule Beats 'Gestalt' in Ruling Out Pulmonary Embolism
Wells Rule Beats 'Gestalt' in Ruling Out Pulmonary Embolism

WEDNESDAY, May 25, 2016 (HealthDay News) -- Both a physician's own probability estimate ("gestalt") and the Wells rule can be combined with D-dimer testing to safely rule out pulmonary embolism (PE) in primary care; however, the Wells rule is more efficient, according to a study published in the May/June issue of the Annals of Family Medicine.

Janneke M.T. Hendriksen, M.D., Ph.D., from the University Medical Center Utrecht in the Netherlands, and colleagues examined the diagnostic performance of the Wells rule and physicians' own probability estimate for safely ruling out PE. Five hundred ninety-eight patients with suspected PE were included; physicians estimated the probability of PE on a scale of 0 to 100 percent and calculated the Wells rule score. The discriminative ability was compared for both approaches. For gestalt, low risk was indicated by a probability of less than 20 percent plus a negative point-of-care D-dimer test. A score of 4 or lower on the Wells rule plus a negative D-dimer test indicated low risk.

The researchers found that 12 percent of patients were confirmed to have venous thromboembolism (a surrogate for PE at baseline) within three months of follow-up. The c-statistic was 0.77 and 0.80 for gestalt and the Wells rules, respectively. The failure rate of gestalt was 1.3 percent, with an efficiency of 25 percent. For the Wells rule the failure rate was 1.5 percent, with efficiency of 45 percent.

"Combined with D-dimer testing, both gestalt using a cut-off of less than 20 percent and the Wells rule using a score of 4 or lower are safe for ruling out PE in primary care," the authors write. "The Wells rule is more efficient, however, and PE can be ruled out in a larger proportion of suspected cases."

Abstract
Full Text

Share this content:

is free, fast, and customized just for you!

Already a member?

Sign In Now »


Sign up for myCME e-newsletters


Drug Lookup

Browse drugs by: BrandGenericDisease


More in Home

ASTRO: No Survival Benefit for Adding EBT to Brachytherapy

ASTRO: No Survival Benefit for Adding EBT to ...

Addition of external beam therapy doesn't improve five-year progression-free survival in prostate cancer

ASTRO: Fewer Side Effects With IMRT in Cervical, Endometrial CA

ASTRO: Fewer Side Effects With IMRT in Cervical, ...

Patients in conventional radiotherapy arm had more high-level adverse events than those in IMRT arm

Many Doctors Reluctant to Reveal Mental Health Issues

Many Doctors Reluctant to Reveal Mental Health Issues

Perceived stigma, fear of career repercussions hinder treatment, study suggests

is free, fast, and customized just for you!

Already a member?

Sign In Now »