Comparison of the effectiveness of clinical judgment, wells score and revised geneva score in suspected pulmonary embolism

BACKGROUND: Shortness of breath and chest pain are the most common presenting symptoms of pulmonary embolism (PE); however, these findings lack both sensitivity and specificity. Therefore, clinical probability assessment remains a key component in the diagnostic evaluation of suspected PE. Clinical prediction rules such as the Wells and Revised Geneva scores are widely used to estimate pre-test probability. OBJECTIVE: This study aimed to compare emergency physicians' clinical judgment with the Wells and Revised Geneva scores in predicting pulmonary embolism in patients presenting to the emergency department with suspected PE. METHODS: This prospective dual-center study included patients presenting to the emergency departments of two tertiary care hospitals with suspected PE. The evaluating emergency physician first assessed the clinical probability of PE (low, intermediate, or high) based solely on clinical judgment. Subsequently, the Wells and Revised Geneva scores were calculated independently by a second physician who was blinded to the initial clinical assessment. The diagnostic performance of clinical judgment, Wells score, and Revised Geneva score was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: A total of 248 patients with suspected PE were included in the study. Pulmonary embolism was confirmed in 38 patients (15.3%). Clinical judgment showed a numerically higher AUC compared with both the Wells and Revised Geneva scores. The area under the ROC curve (AUC) was 0.834 for clinical judgment, 0.766 for the Wells score, and 0.757 for the Revised Geneva score. CONCLUSION: In patients presenting with suspected pulmonary embolism, emergency physicians clinical judgment showed favorable diagnostic discrimination and a numerically higher AUC than the Wells and Revised Geneva scores. These findings suggest that clinical assessment remains a valuable component of the diagnostic approach to suspected PE.