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Atrial fibrillation, an obscured cause of pulmonary embolism can be revealed by adding to Wells criteria
  1. Canan Hasanoğlu1,
  2. Emine Argüder1,
  3. Hatice Kılıç1,
  4. Ebru Sengul Parlak2,
  5. Ayşegül Karalezli1
  1. 1 Chest Diseases, Yildirim Beyazit Universitesi Tip Fakultesi, Ankara, Turkey
  2. 2 Chest Diseases, Ankara Ataturk Egitim ve Arastirma Hastanesi, Ankara, Turkey
  1. Correspondence to Dr Emine Argüder, Chest Diseases, Ankara 06800, Turkey; drgullu2000{at}


Among the various clinical scoring methods used for the prediagnosis of pulmonary embolism (PE), Wells criteria is the most common. It relies on the findings and story of deep venous thrombosis (DVT), PE and malignancy. It is known that atrial fibrillation (AF) is a risk factor for PE like as DVT or malignancy. We aimed to evaluate the possibility of diagnosing more patients with PE by including AF in the Wells criteria. This prospective study included 250 patients admitted to the emergency department with PE findings. Wells scoring and Wells scoring with AF were performed for each patient. Out of 250 patients, 165 patients were diagnosed as PE. Wells score was >4 in 61.8% of patients with PE and 28.2% of patients without PE. Out of false negative 63 patients with PE, 21 of them had AF. According to Wells scoring with AF the score of 148 (89.7%) patients with PE diagnosis was ≥3, whereas the score of 45 (52.9%) patients without PE was ≥3. AF was detected in 15.8% of patients with PE. The sensitivity of Wells score with AF was significantly higher than that of the Wells score (p<0.001). As a result, when AF, which is one of an important PE cause such as DVT and malignancy, was added to the Wells criteria, an additional correct PE estimate was obtained in 46 patients. We recommend using Wells score with AF since prediagnosing more PE is more valuable than having some false negative PE predictions.

  • atrial fibrillation
  • pulmonary embolism

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  • Contributors Planning: Canan Hasanoglu, Conduct: Canan Hasanoglu, Emine Argüder, Hatice Kılıç, Ebru Sengul Parlak, Ayşegül Karalezli, Reporting: Canan Hasanoglu, Emine Argüder, Revision: Canan Hasanoglu, Michael J McPhaul.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The regional committee of medical and health research ethics approved the study (no.: 2011-12-116).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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