Risk stratifying emergency department patients with acute pulmonary embolism: Does the simplified Pulmonary Embolism Severity Index perform as well as the original?

Vinson, David R; Ballard, Dustin W; Mark, Dustin G; Huang, Jie; Reed, Mary E; Rauchwerger, Adina S; Wang, David H; Lin, James S; Kene, Mamata V; Pleshakov, Tamara S; Sax, Dana K; Sax, Jordan M; McLachlan, D Ian; Yamin, Cyrus K; Swap, Clifford J; Iskin, Hilary R; Vemula, Ridhima; Fleming, Bethany S; Elms, Andrew R and Aujesky, Drahomir (2016). Risk stratifying emergency department patients with acute pulmonary embolism: Does the simplified Pulmonary Embolism Severity Index perform as well as the original? Thrombosis research, 148, pp. 1-8. Elsevier 10.1016/j.thromres.2016.09.023

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INTRODUCTION The Pulmonary Embolism Severity Index (PESI) is a validated prognostic score to estimate the 30-day mortality of emergency department (ED) patients with acute pulmonary embolism (PE). A simplified version (sPESI) was derived but has not been as well studied in the U.S. We sought to validate both indices in a community hospital setting in the U.S. and compare their performance in predicting 30-day all-cause mortality and classification of cases into low-risk and higher-risk categories. MATERIALS AND METHODS This retrospective cohort study included adults with acute objectively confirmed PE from 1/2013 to 4/2015 across 21 community EDs. We evaluated the misclassification rate of the sPESI compared with the PESI. We assessed accuracy of both indices with regard to 30-day mortality. RESULTS Among 3006 cases of acute PE, the 30-day all-cause mortality rate was 4.4%. The sPESI performed as well as the PESI in identifying low-risk patients: both had similar sensitivities, negative predictive values, and negative likelihood ratios. The sPESI, however, classified a smaller proportion of patients as low risk than the PESI (27.5% vs. 41.0%), but with similar low-risk mortality rates (<1%). Compared with the PESI, the sPESI overclassified 443 low-risk patients (14.7%) as higher risk, yet their 30-day mortality was 0.7%. The sPESI underclassified 100 higher-risk patients (3.3%) as low risk who also had a low mortality rate (1.0%). CONCLUSIONS Both indices identified patients with PE who were at low risk for 30-day mortality. The sPESI, however, misclassified a significant number of low-mortality patients as higher risk, which could lead to unnecessary hospitalizations.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Aujesky, Drahomir

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0049-3848

Publisher:

Elsevier

Language:

English

Submitter:

Jacques Donzé

Date Deposited:

16 Feb 2017 11:13

Last Modified:

16 Feb 2017 11:13

Publisher DOI:

10.1016/j.thromres.2016.09.023

PubMed ID:

27764729

Uncontrolled Keywords:

Clinical prediction rule; Decision support techniques; Prognosis; Pulmonary embolism; Risk assessment; Severity of illness index

BORIS DOI:

10.7892/boris.94680

URI:

https://boris.unibe.ch/id/eprint/94680

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