常用指南推荐的影像学检查前的急性肺栓塞（PE）预测规则如果不与D-二聚体联合诊断效率较低，因此有必要寻求诊断效率更高的预测规则。我们设计了一种新的预测规则。通过综合开发组患者（n = 2112）的 Wells、PERC、Geneva 以及 D-二聚体评分，得出名为 Legend 的评分，然后在验证组患者（n = 388）中进行验证。还比较了 Legend 评分与 Wells D-二聚体 (DD)、PERC DD、Geneva DD 和 YEARS DD（YEAR 算法）的诊断效率。Legend 评分包括活动性癌症、D-二聚体≥1000 ng/mL、DVT 症状和/或体征、既往静脉血栓栓塞 (VTE) 病史以及过去一个月的手术、创伤或制动情况。原始 Legend 评分的敏感性、特异性、Youden 指数和曲线下面积 (AUC) 分别为 0.985、0.744、0.729 和 (0.861[0.796-0.925], P<0.001)，而对于简化的 Legend 分数，分别为 0.760 和 (0.871[0.823-0.920]，P<0.001)。原始和简化的 Legend 分数之间的 Kappa 系数和 McNemar 检验的 P 值分别为 0.988 和 1.000。在验证组中，原始 Legend 评分的敏感性、特异性、Youden 指数和 C 指数分别为 0.971、0.749、0.720 和 (0.838[0.781-0.896]，P<0.001)，而对于简化的 Legend 分数，分别为 0.715、0.701 和 (0.816[0.750-0.880]，P = 0.001)。原始 Legend 评分与 Wells DD、PERC DD、Geneva DD 和 YEARS DD 之间的 Kappa 系数和 McNemar 检验 P 值分别为 (0.563, 0.001)、(0.139, <0.001)、(0.631, 0.006) 和 (0.732, 0.029），分别。简化Legend评分与上述评分之间的Kappa系数和McNemar检验的P值分别为(0.675, 0.009)、(0.172, <0.001)、(0.747, 0.001)和(0.883, 0.012)。 Legend评分保留了Wells、PERC和修订后的Geneva评分中的高效预测因子，消除了低效预测因子，并将D-二聚体纳入其中，一种更高效、修改和用户友好的预测因子取代了原来的预测因子。在影像学检查之前对急性肺栓塞进行测试前预测时，可产生出色的诊断效率和良好的安全性。与 Wells DD、PERC DD、Geneva DD 或 YEARS DD 相比，它还避免了更多不必要的影像学检查。版权所有 © 2023 Sociedade Portuguesa de Pneumologia。由 Elsevier España 出版，S.L.U.版权所有。

The prediction rules of acute pulmonary embolism(PE) before imaging tests recommended by the commonly used guidelines have low diagnostic efficiency if not combined with D-dimer, therefore it is necessary to seek for a prediction rule with higher diagnostic efficiency.We designed a new score named Legend by synthesizing the scores of Wells, PERC, and Geneva, as well as D-dimer with patients in the development group(n = 2112), and then validated it in patients of validation group(n = 388). Diagnostic efficiency was also compared between Legend score and Wells+D-dimer (DD), PERC+DD, Geneva+DD, and YEARS+DD(YEAR algorithm).The Legend score comprised active cancer, D-dimer≥1000 ng/mL, DVT symptoms and/or signs, previous venous thromboembolism (VTE) history, and surgery, trauma, or immobilization in the past month. The sensitivity, specificity, Youden index, and area under the curve(AUC) were 0.985, 0.744, 0.729, and (0.861[0.796-0.925], P<0.001), respectively, for original Legend score, whereas were 0.982, 0.778, 0.760, and (0.871[0.823-0.920], P<0.001), respectively, for simplified Legend score. The Kappa coefficient and P value of McNemar test were 0.988 and 1.000, respectively, between the original and simplified Legend scores. In the validation group, the sensitivity, specificity, Youden index, and C-index were 0.971, 0.749, 0.720, and (0.838[0.781-0.896], P<0.001), respectively, for the original Legend score, whereas were 0.986, 0.715, 0.701, and (0.816[0.750-0.880], P = 0.001) respectively, for the simplified Legend score. The Kappa coefficient and P value of McNemar test between original Legend score and Wells+DD, PERC+DD, Geneva+DD, and YEARS+DD were (0.563, 0.001), (0.139, <0.001), (0.631, 0.006), and (0.732, 0.029), respectively. The Kappa coefficient and P value of McNemar test between simplified Legend score and aforementioned scores were (0.675, 0.009), (0.172, <0.001), (0.747, 0.001), and (0.883, 0.012), respectively.In view of the fact the Legend score reserves the efficient predictors and eliminates the inefficient ones in Wells, PERC, and revised Geneva scores, and incorporates D-dimer into it, a more efficient, modified, and user-friendly one has replaced the original ones.The Legend score yields excellent diagnostic efficiency with good safety in the pretest prediction of acute PE prior to imaging tests. It also avoids more unnecessary imaging tests than Wells+DD, PERC+DD, Geneva+DD, or YEARS+DD.Copyright © 2023 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.