Pretest Probability for PE: Structured Scoring System or Clinical Judgment?

Quantitative estimates of the likelihood of pulmonary embolus (PE) are commonly used in research protocols and have infiltrated routine practice in many settings. But are these structured scores better than a physician's judgment? Investigators reviewed data for 1038 French and Belgian patients who had been included in a prospective cohort study of suspected PE.

In the original prospective study, emergency physicians (including physicians in training) had recorded their gestalt impression of the likelihood of PE (low, moderate, or high) as well as clinical variables. In the current study, researchers retrospectively calculated the Wells score and the revised Geneva score, and compared them to the physicians' gestalt.

Clinical judgment outperf…