The elderly are at high risk for acute pulmonary embolism (APE) , and the difficulty of early identification and diagnosis of APE in the elderly has made the active search for an optimal prediction method for elderly patients with suspected APE a medical problem that must be faced.

To investigate the predictive value of the 4-level Clinical Pretest Probability Score (4PEPS) for pulmonary embolism (PE) in elderly patients with suspected APE.

Basic information and related clinical data were collected from elderly (age≥60 years) hospitalized patients who completed spiral CT pulmonary arteriography (CTPA) examinations in the Third Affiliated Hospital of Zunyi Medical University from 2017 to 2021. The study subjects were divided into the APE group and non-APE group according to the CTPA criteria for the diagnosis of PE in 2018 Guidelines for the Diagnosis, Treatment and Prevention of Pulmonary Thromboembolism. The 4PEPS, Standard algorithm, age-adjusted D-dimer (AADD) algorithm, YEARS algorithm and pulmonary embolism graduated D-dimer (PEGeD) algorithm were used to predict the APE of the study subjects, respectively, who were divided into the positive and negative groups, and the number of true positives, true negatives, false positives and false negatives of each prediction method was counted. The efficacy evaluation indexes of the five prediction method were calculated and their prediction values were compared.

Among 1 193 elderly hospitalized patients who completed CTPA examination, 608 (50.96%) were male and 585 (49.04%) were female, with a median age of 74 (68, 81) years; 323 (27.07%) were APE patients and 870 (72.93%) were non-APE patients; there was no statistically significant difference between elderly APE patients and elderly non-APE patients in terms of gender and age (P>0.05) . 4PEPS, AADD algorithm, Standard algorithm, YEARS algorithm and PEGeD algorithm for elderly patients with suspected APE had a sensitivity of 95.05%, 97.83%, 98.76%, 97.21%, 97.83%, the specificity of 31.84%, 18.16%, 12.87%, 22.41%, 22.41%, the correctness of 48.95%, 39.73%, 36.13%, 42.67%, 42.83%, Youden index of 0.27, 0.16, 0.12, 0.20, 0.20. The net reclassification improvement (NRI) of 4PEPS, Standard algorithm, YEARS algorithm and PEGeD algorithm compared to AADD algorithm were 0.218, -0.087, 0.073, and 0.085, the difference of the NRI of 4PEPS compared to AADD algorithm was statistically significant (P<0.05) .

4PEPS predicts elderly patients with suspected APE with high specificity, correctness, and Youden index, and the overall predictive value is significantly better than the remaining four methods, which may be the optimal prediction method for elderly patients with APE.

老年人是发生急性肺栓塞（APE）的高危人群，而老年APE早期患者识别及诊断困难，积极寻找一种对老年疑似APE患者的最优预测方法，已成为必须面对的医学问题。

探讨4级肺栓塞临床概率评分（4PEPS）在老年疑似APE患者中的预测价值。

收集2017—2021年于遵义医科大学第三附属医院完成螺旋CT肺动脉造影（CTPA）检查的老年（年龄≥60岁）住院患者的基本信息及相关临床数据。参照2018年《肺血栓栓塞症诊治与预防指南》CTPA诊断肺栓塞标准，将研究对象分为APE组和非APE组。分别采用4PEPS、Standard算法、年龄校正的D-二聚体（AADD）算法、YEARS算法及PEGeD算法对研究对象进行APE预测，根据预测结果分为阳性组和阴性组，统计各预测方法的真阳性人数、真阴性人数、假阳性人数、假阴性人数。计算5种预测方法的效能评价指标并对其预测价值进行比较。

1 193例完成CTPA检查的老年住院患者中，男608例（50.96%），女585例（49.04%），中位年龄为74（68，81）岁，APE患者323例（27.07%），非APE患者870例（72.93%）；老年APE与非APE患者性别、年龄比较，差异无统计学意义（P>0.05）。4PEPS、AADD算法、Standard算法、YEARS算法及PEGeD算法预测老年疑似APE患者的灵敏度分别为95.05%、97.83%、98.76%、97.21%、97.83%，特异度分别为31.84%、18.16%、12.87%、22.41%、22.41%，正确率分别为48.95%、39.73%、36.13%、42.67%、42.83%，Youden指数分别为0.27、0.16、0.12、0.20、0.20。4PEPS、Standard算法、YEARS算法及PEGeD算法对比AADD算法的净重新分类指数（NRI）分别为0.218、-0.087、0.073、0.085，其中4PEPS对比AADD算法的NRI差异有统计学意义（P<0.05）。

4PEPS预测老年疑似APE患者的特异度、正确率、Youden指数较高，总体预测价值明显优于其余4种方法，可能是老年APE患者的最优预测方法。