European journal of radiology open · 2026
Concordance of the modified wells score with CTPA-confirmed pulmonary embolism in an imaging-selected cohort: A retrospective single-center study.
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Costantini Pietro, Ostillio Eleonora, Razzini Davide, Spagnolo Rita, Fabbricatore Davide, Leonetti Anna Carmen, Minelli Pierluca, Leocata Giorgia Angela Agata, Carriero Alessandro, Colarieti Anna
Аннотация
BACKGROUND: Pulmonary embolism (PE) is a major diagnostic challenge in emergency medicine. Computed tomography pulmonary angiography (CTPA) is the gold standard but is frequently overused. The modified Wells Score (mWS) estimates pre-test probability and may reduce inappropriate imaging at triage. We evaluated the concordance between mWS and CTPA-confirmed PE in a tertiary emergency department.
METHODS: We retrospectively analyzed all patients undergoing CTPA for suspected PE over 24 months. As all patients had already undergone CTPA, this design reflects concordance within an imaging-selected cohort, not triage performance. mWS values were assigned by consensus between two readers, blinded to CTPA results; D-dimer was not incorporated. AUC was computed from the full ordinal mWS range; sensitivity, specificity, PPV and NPV were calculated at the conventional mWS ≥ 4 threshold. Spearman's correlation assessed the mWS-PE severity association.
RESULTS: Among 691 patients, 103 (14.9%) had CTPA-confirmed PE. At mWS ≥ 4, sensitivity was 86.4%, specificity 98.6%, AUC 0.943 (95% CI: 0.91-0.97). The Youden index identified mWS ≥ 3 as optimal (sensitivity 89.3%, specificity 95.7%); ≥ 4 was retained for analysis. Under this threshold, 594 patients (86.0%) fell below the cut-off, suggesting avoidable imaging, though unconfirmed in non-imaged patients. Fourteen false-negative (3 central PE) and eight false-positive cases were identified. Higher mWS correlated moderately with PE burden (ρ = 0.578, p < 0.01).
CONCLUSION: mWS showed strong concordance with CTPA-confirmed PE; diagnostic accuracy exceeding pooled meta-analytic estimates likely reflects consensus-scoring methodology rather than genuine superiority. Prospective, multicentre validation incorporating D-dimer testing and independent scoring is warranted before routine implementation.
METHODS: We retrospectively analyzed all patients undergoing CTPA for suspected PE over 24 months. As all patients had already undergone CTPA, this design reflects concordance within an imaging-selected cohort, not triage performance. mWS values were assigned by consensus between two readers, blinded to CTPA results; D-dimer was not incorporated. AUC was computed from the full ordinal mWS range; sensitivity, specificity, PPV and NPV were calculated at the conventional mWS ≥ 4 threshold. Spearman's correlation assessed the mWS-PE severity association.
RESULTS: Among 691 patients, 103 (14.9%) had CTPA-confirmed PE. At mWS ≥ 4, sensitivity was 86.4%, specificity 98.6%, AUC 0.943 (95% CI: 0.91-0.97). The Youden index identified mWS ≥ 3 as optimal (sensitivity 89.3%, specificity 95.7%); ≥ 4 was retained for analysis. Under this threshold, 594 patients (86.0%) fell below the cut-off, suggesting avoidable imaging, though unconfirmed in non-imaged patients. Fourteen false-negative (3 central PE) and eight false-positive cases were identified. Higher mWS correlated moderately with PE burden (ρ = 0.578, p < 0.01).
CONCLUSION: mWS showed strong concordance with CTPA-confirmed PE; diagnostic accuracy exceeding pooled meta-analytic estimates likely reflects consensus-scoring methodology rather than genuine superiority. Prospective, multicentre validation incorporating D-dimer testing and independent scoring is warranted before routine implementation.