(1360) Assessment of the Revised Geneva Score as a Prognostic Index for the Severity of Pulmonary Embolism

Introduction: Pulmonary embolism (PE) is a common cause of emergency hospitalization. Standard guidelines recommend outpatient management for low-risk PE thereby emphasizing the need for adequate risk stratification. The diagnostic utility of the revised Geneva score (rGS) in PE prediction has been well validated. We aimed to assess the utility of the rGS as a prognostic index to detect the severity of PE.

Methods: We conducted a retrospective cohort study on adults diagnosed with PE. We excluded pregnant patients. We collected demographic information, parameters to calculate the rGS, and outcomes such as ICU admission, right ventricular (RV) strain, and mortality rate. Patients were categorized into two groups based on a cutoff of 4 points in the rGS, because it correlated with an intermediate risk of PE per existing literature. We used Fisher’s exact test for categorical variables. We also calculated the logistic regression between the covariates and outcomes. The significance was set at 5%

Results: Of the 410 patients screened, 323 met the inclusion criteria. Baseline demographics such as gender and associated comorbidities were equally distributed between the two groups. A significant difference was noted in the incidence of RV strain (36% vs 16.4%, p-0.007), ICU admission (25.89% vs 13.2%, p-0.031), and mortality (11 % vs 7.6%, p-0.003) between the two groups. Further logistic regression analysis showed similar findings of a greater incidence of RV strain (OR-1.35, CI:1.16-1.75), ICU admission (OR-1.43, CI:1.21-1.92), and Mortality (OR-4.23, CI:1.61-11.1) in patients with a rGS ≥ 4 compared to those with a rGS < 4.

Conclusions: Our pilot study showed a greater incidence of poor prognostic outcomes such as RV strain, ICU admission, and mortality rate amongst patients who scored four or more points on the rGS thereby suggesting the value of this scoring system as a good prognostic tool to assist in risk stratification. The rGS encompasses eight variables that contribute individually to PE severity risk, which explains the greater incidence of poor outcomes as the rGS increases. Considering the findings of our single-center study, we would recommend a large-scale prospective trial to prospectively validate the rGS as a prognostic tool to determine the severity of PE.