Risk stratification and outcomes in hemodynamically stable patients with acute pulmonary embolism: a prospective multicenter, cohort study: reply to a rebuttal

SummaryThe recently introduced simplified Wells rule for the exclusion of pulmonary embolism (PE) assigns only one point to the seven variables of the original Wells rule. This study was performed to independently validate the simplified Wells rule for the exclusion of PE. We retrospectively calculated the prevalence of PE in the “unlikely” probability categories of the original Wells (cut-off ≤4) and the simplified Wells rule (cut-off ≤1) in 922 consecutive patients with clinically suspected PE from a multicenter cohort study. We compared the three-month incidence of venous thromboembolism (VTE) in patients with an unlikely probability and a normal D-dimer test using both scores, and the proportion of patients with this combination (clinical utility). The proportion of patients categorized as PE “unlikely” was similar using the original (78%) and the simplified (70%) Wells rule. The prevalence of PE was 13% (95% confidence interval [CI], 11–16%) and 12% (95%CI, 9.7–15%) for the original Wells and simplified Wells “unlikely” categories, respectively. None of the patients with PE “unlikely” and a normal D-dimer test experienced VTE during three-month follow-up. The proportions of patients in whom further tests could safely be withheld based on PE “unlikely” and a normal D-dimer test was 28% (95%CI, 25–31%) using the original and 26% (95%CI, 24–29%) using the simplified Wells rule. In this external retrospective validation study, the simplified Wells rule appeared to be safe and clinically useful, although prospective validation remains necessary. Simplification of the Wells rule may enhance the applicability.

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Risk stratification to predict pain during unsedated colonoscopy: results of a multicenter cohort study

Endoscopy ◽

10.1055/s-0033-1344239 ◽

2013 ◽

Vol 45 (09) ◽

pp. 691-696 ◽

Cited By ~ 12

Author(s):

Øyvind Holme ◽

Michael Bretthauer ◽

Thomas de Lange ◽

Birgitte Seip ◽

Gert Huppertz-Hauss ◽

...

Keyword(s):

Cohort Study ◽

Risk Stratification ◽

Multicenter Cohort Study ◽

Multicenter Cohort

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Risk, clinical course and outcome of ischemic stroke in patients hospitalized with COVID-19: a multicenter cohort study

10.1101/2021.03.11.21253189 ◽

2021 ◽

Author(s):

Wouter M. Sluis ◽

Marijke Linschoten ◽

Julie E. Buijs ◽

J. Matthijs Biesbroek ◽

Heleen M. den Hertog ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Cohort Study ◽

Ischemic Stroke ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Cumulative Incidence ◽

Stroke Patients ◽

Multicenter Cohort Study ◽

Multicenter Cohort

AbstractBackground and purposeThe frequency of ischemic stroke in patients with COVID-19 varies in the current literature, and risk factors are unknown. We assessed the incidence, risk factors, and outcomes of acute ischemic stroke in hospitalized patients with COVID-19.MethodsWe included patients with a laboratory confirmed SARS-CoV-2 infection admitted in 16 hospitals participating in the international CAPACITY-COVID registry between March 1st and August 1st, 2020. Patients were screened for the occurrence of acute ischemic stroke. We calculated the cumulative incidence of ischemic stroke and compared risk factors, cardiovascular complications, and in-hospital mortality in patients with and without ischemic stroke.ResultsWe included 2147 patients with COVID-19, of whom 586 (27.3%) needed treatment at an intensive care unit (ICU). Thirty-eight patients (1.8%) had an ischemic stroke. Patients with stroke were older, but did not differ in sex or cardiovascular risk factors. Median time between onset of COVID-19 symptoms and diagnosis of stroke was two weeks. The incidence of ischemic stroke was higher among patients who were treated at an ICU (16/586; 2.7% versus 22/1561; 1.4%; p=0.039). Pulmonary embolism was more common in patients with (8/38; 21.1%) than in those without stroke (160/2109; 7.6%; adjusted RR: 2.08; 95%CI:1.52-2.84). Twenty-seven patients with ischemic stroke (71.1%) died during admission or were functional dependent at discharge and in-hospital mortality. Patients with ischemic stroke were at a higher risk of in-hospital mortality (adjusted RR 1.56; 95%CI:1.13-2.15) than patients without stroke.ConclusionsIn this multicenter cohort study, the cumulative incidence of acute ischemic stroke in hospitalized patients with COVID-19 was approximately 2%, with a higher risk in patients treated at an ICU. The majority of stroke patients had a poor outcome. The association between ischemic stroke and pulmonary embolism warrants further investigation.

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