A comparison of the original and simplified Pulmonary Embolism Severity Index

2011 ◽  
Vol 106 (09) ◽  
pp. 423-428 ◽  
Author(s):  
Carmen Venetz ◽  
David Jiménez ◽  
Marie Méan ◽  
Drahomir Aujesky
Keyword(s):  
Pulmonary Embolism ◽  
Characteristic Curve ◽  
Severity Index ◽  
Adverse Outcomes ◽  
Low Risk ◽  
Discriminatory Power ◽  
University Hospital ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Risk Patients

SummaryThe Pulmonary Embolism Severity Index (PESI) is a validated clinical prognostic model for patients with pulmonary embolism (PE). Recently, a simplified version of the PESI was developed. We sought to compare the prognostic performance of the original and simplified PESI. Using data from 15,531 patients with PE, we compared the proportions of patients classified as low versus higher risk between the original and simplified PESI and estimated 30-day mortality within each risk group. To assess the models’ accuracy to predict mortality, we calculated sensitivity, specificity, and predictive values and likelihood ratios for low-versus higher-risk patients. We also compared the models’ discriminative power by calculating the area under the receiver-operating characteristic curve. The overall 30-day mortality was 9.3%. The original PESI classified a significantly greater proportion of patients as low-risk than the simplified PESI (40.9% vs. 36.8%; p<0.001). Low-risk patients based on the original and simplified PESI had a mortality of 2.3% and 2.7%, respectively. The original and simplified PESI had similar sensitivities (90% vs. 89%), negative predictive values (98% vs. 97%), and negative likelihood ratios (0.23 vs. 0.28) for predicting mortality. The original PESI had a significantly greater discriminatory power than the simplified PESI (area under the ROC curve 0.78 [95% CI: 0.77–0.79] vs. 0.72 [95% CI: 0.71–0.74]; p<0.001). In conclusion, even though the simplified PESI accurately identified patients at low-risk of adverse outcomes, the original PESI classified a higher proportion of patients as low-risk and had a greater discriminatory power than the simplified PESI.Institution where the work was carried out: Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland.

Prospective validation of the Pulmonary Embolism Severity Index

2008 ◽  
Vol 100 (05) ◽  
pp. 943-948 ◽  
Author(s):  
Grégoire Gal ◽  
Michael J. Fine ◽  
Pierre-Marie Roy ◽  
Olivier Sanchez ◽  
Franck Verschuren ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Roc Curve ◽  
Outpatient Care ◽  
Prediction Rule ◽  
Severity Index ◽  
Low Risk ◽  
Predictive Values ◽  
Risk Of Death ◽  
Risk Patients ◽  
Overall Mortality

SummaryPractice guidelines recommend outpatient care for selected patients with non-massive pulmonary embolism (PE), but fail to specify how these low-risk patients should be identified. Using data from U.S. patients, we previously derived the Pulmonary Embolism Severity Index (PESI), a prediction rule that risk stratifies patients with PE. We sought to validate the PESI in a European patient cohort. We prospectively validated the PESI in patients with PE diagnosed at six emergency departments in three European countries. We used baseline data for the rule’s 11 prognostic variables to stratify patients into five risk classes (I-V) of increasing probability of mortality. The outcome was overall mortality at 90 days after presentation.To assess the accuracy of the PESI to predict mortality, we estimated the sensitivity, specificity, and predictive values for low- (risk classes I/II) versus higher- risk patients (risk classes III-V), and the discriminatory power using the area under the receiver operating characteristic (ROC) curve. Among 357 patients with PE, overall mortality was 5.9%, ranging from 0% in class I to 17.9% in class V. The 186 (52%) low-risk patients had an overall mortality of 1.1% (95% confidence interval [CI]: 0.1–3.8%) compared to 11.1% (95% CI: 6.8–16.8%) in the 171 (48%) higher- risk patients. The PESI had a high sensitivity (91%,95% CI: 71–97%) and a negative predictive value (99%, 95% CI: 96–100%) for predicting mortality. The area under the ROC curve was 0.78 (95% CI:0.70–0.86). The PESI reliably identifies patients with PE who are at low risk of death and who are potential candidates for outpatient care. The PESI may help physicians make more rational decisions about hospitalization for patients with PE.

Measurement of High-Sensitivity Cardiac Troponin in Pulmonary Embolism: Useful Test or a Clinical Distraction

2019 ◽  
Vol 45 (08) ◽  
pp. 784-792
Author(s):  
Giuseppe Lippi ◽  
Emmanuel J. Favaloro ◽  
Peter Kavsak
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Cardiac Troponin ◽  
Laboratory Tests ◽  
High Sensitivity ◽  
Severity Index ◽  
Adverse Outcomes ◽  
Incremental Value ◽  
Risk Patients ◽  
Acute Pe

AbstractThe ability to predict death or other unfavorable outcomes after an acute pulmonary embolism (PE) is challenging, with current available risk score models having relatively unsatisfactory prognostic performance in this area. For example, the simplified pulmonary embolism severity index (sPESI), the most frequently used stratification tool, misclassifies a significant percentage of low- and high-risk patients. This gap in care, along with the increasing clinical availability of high-sensitivity cardiac troponin (hs-cTn) laboratory tests and the recent emphasis on detecting myocardial injury, may foster further evaluation of hs-cTn testing in patients with acute PE. Our analysis of the current scientific literature on hs-cTn in patients with acute PE identified that hs-cTn testing may provide valuable information for predicting future adverse outcomes and mortality, independently from baseline clinical risk assessment. Although the risk of an adverse event is indeed higher in patients with higher sPESI scores, cTns retain their prognostic value also in those at low risk, suggesting that a combination of hs-cTn with sPESI may provide an incremental value over assessment of either variable alone. Accordingly, the future development of updated risk stratification models, with the inclusion of laboratory tests such as hs-cTn, may represent an enhanced approach for risk stratification in patients with acute PE. Additional research, however, is needed to verify whether the combination of cTns, specifically as measured with hs-cTn assays, with other biomarkers may further improve the current capacity to efficiently manage patients with acute PE.

Does the Pulmonary Embolism Severity Index accurately identify low risk patients eligible for outpatient treatment?

2012 ◽  
Vol 129 (6) ◽  
pp. 710-714 ◽  
Author(s):  
Petra M.G. Erkens ◽  
Esteban Gandara ◽  
Philip S. Wells ◽  
Alex Yi-Hao Shen ◽  
Gauruv Bose ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Outpatient Treatment ◽  
Severity Index ◽  
Low Risk ◽  
Risk Patients

Validation of a risk score identifying patients with acute pulmonary embolism, who are at low risk of clinical adverse outcome

2004 ◽  
Vol 91 (06) ◽  
pp. 1232-1236 ◽  
Author(s):  
Patrick Bandelier ◽  
Drahomir Aujesky ◽  
Jacques Cornuz ◽  
Pierre-Marie Roy ◽  
Henri Bounameaux ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Risk Score ◽  
Acute Pulmonary Embolism ◽  
Predictive Accuracy ◽  
Adverse Outcome ◽  
Characteristic Curve ◽  
Prognostic Score ◽  
Adverse Outcomes ◽  
Low Risk ◽  
Score Distribution

SummaryA clinical predictive model that accurately identifies patients with pulmonary embolism who are at low risk of adverse medical outcomes may be useful for management decisions, such as outpatient treatment. We aimed to externally validate a previously derived prognostic score identifying emergency ward patients with acute pulmonary embolism at low risk of 3- month complications. One hundred and ninety-nine consecutive patients with proven pulmonary embolism were included from the emergency centres of three teaching and general hospitals. Adverse outcomes, such as death, major bleed, or recurrent venous thromboembolism, were recorded during a 3-month follow-up. We retrospectively computed the prognostic score for each patient and determined its predictive accuracy at different threshold values. The overall 3-month risk of adverse event after the diagnosis of pulmonary embolism was 9.5%. At a threshold of 2 points, eight patients with scores at or below the cut-off (5%; 95% CI 2.6–9.6) and 11 patients with scores above this cut-off (27.5%; 95% CI 16.1–42.8) presented a complication. The negative predictive value for an adverse outcome was 95.0% (95% CI 90.4–97.4). The receiver operating characteristic curve derived from the score distribution had an area of 0.77 (95% CI 0.65–0.89). This compared favourably with the characteristics of the derivation study. We conclude that the Geneva risk score has an acceptable predictive accuracy to identify patients with pulmonary embolism at low risk for 3-month adverse outcomes. Whether this score remains accurate and useful in clinical practice should be determined in a prospective multicentre validation study.

scholarly journals Is the Pulmonary Embolism Severity Index Being Routinely Used in Clinical Practice?

Thrombosis ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Ali Shafiq ◽  
Hamza Lodhi ◽  
Zaheer Ahmed ◽  
Ata Bajwa
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Risk Groups ◽  
Severity Index ◽  
Low Risk ◽  
Significant Difference ◽  
Risk Patients ◽  
Acute Pe

Background. The Pulmonary Embolism Severity Index (PESI) score can risk-stratify patients with PE but its widespread use is uncertain. With the PESI, we compared length of hospital stay between low, moderate, and high risk PE patients and determined the number of low risk PE patients who were discharged early. Methods. PE patients admitted to St. Joseph Mercy Oakland Hospital from January 2005 to August 2010 were screened. PESI score stratified acute PE patients into low (<85), moderate (86–105), and high (>105) risk categories and their length of hospital stay was compared. Patients with low risk PE discharged early (≤3 days) were calculated. Results. Among 315 PE patients, 51.7% were at low risk. No significant difference in hospital stay between low (7.11 ± 3 d) and moderate (6.88 ± 2.9 d) risk, p > 0.05, as well as low and high risk (7.28 ± 3.0 d), p > 0.05, was found. 9% of low risk patients were discharged ≤ 3 days. Conclusions. There was no significant difference in length of hospital stay between low and high risk groups and only a small number of low risk patients were discharged from the hospital early suggesting that risk tools like PESI may not have a widespread use.

scholarly journals Cardiac troponin testing and the simplified Pulmonary Embolism Severity Index

2011 ◽  
Vol 106 (11) ◽  
pp. 978-984 ◽  
Author(s):  
David Spirk ◽  
Drahomir Aujesky ◽  
Marc Husmann ◽  
Daniel Hayoz ◽  
Thomas Baldi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Troponin ◽  
Prognostic Value ◽  
Troponin T ◽  
Characteristic Curve ◽  
Early Death ◽  
Severity Index ◽  
Highly Sensitive ◽  
Risk Patients ◽  
Highly Sensitive Troponin

SummaryA low simplified Pulmonary Embolism Severity Index (sPESI), defined as age ≤80 years and absence of systemic hypotension, tachycardia, hypoxia, cancer, heart failure, and lung disease, identifies low-risk patients with acute pulmonary embolism (PE). It is unknown whether cardiac troponin testing improves the prediction of clinical outcomes if the sPESI is not low. In the prospective Swiss Venous Thromboembolism Registry, 369 patients with acute PE and a troponin test (conventional troponin T or I, highly sensitive troponin T) were enrolled from 18 hospitals. A positive test result was defined as a troponin level above the manufacturers assay threshold. Among the 106 (29%) patients with low sPESI, the rate of mortality or PE recurrence at 30 days was 1.0%. Among the 263 (71%) patients with high sPESI, 177 (67%) were troponin-negative and 86 (33%) troponin-positive; the rate of mortality or PE recurrence at 30 days was 4.6% vs. 12.8% (p=0.015), respectively. Overall, risk assessment with a troponin test (hazard ratio [HR] 3.39, 95% confidence interval [CI] 1.38–8.37; p=0.008) maintained its prognostic value for mortality or PE recurrence when adjusted for sPESI (HR 5.80, 95%CI 0.76–44.10; p=0.09). The combination of sPESI with a troponin test resulted in a greater area under the receiver-operating characteristic curve (HR 0.72, 95% CI 0.63–0.81) than sPESI alone (HR 0.63, 95% CI 0.57–0.68) (p=0.023). In conclusion, although cardiac troponin testing may not be required in patients with a low sPESI, it adds prognostic value for early death and recurrence for patients with a high sPESI.

Association between the Pulmonary Embolism Severity Index (PESI) and short-term clinical deterioration

2011 ◽  
Vol 105 (04) ◽  
pp. 706-711 ◽  
Author(s):  
Praveen Hariharan ◽  
James Kimo Takayesu ◽  
Christopher Kabrhel
Keyword(s):  
Pulmonary Embolism ◽  
Life Support ◽  
Severity Index ◽  
Advanced Cardiac Life Support ◽  
Adverse Outcomes ◽  
Low Risk ◽  
Clinical Event ◽  
Composite Outcome ◽  
Test Characteristics ◽  
Emergency Department Patients

SummaryThe Pulmonary Embolism Severity Index (PESI) has been shown to predict 30 and 90 day mortality after PE. However, whether the PESI predicts patients who will be free of clinically adverse outcomes during a typical hospitalisation is not known. Retrospective analysis of Emergency Department patients with PE from May 2006 to April 2008. We compiled demographics, data to calculate the PESI and a composite outcome. Patients were considered to have a negative PESI if they were in category I or II (≤85 points). Patients were considered to have the composite outcome if, within five days of diagnosis, they: A) had recurrent PE; B) developed a new cardiac dysrhythmia; C) required advanced cardiac life support; D) required respiratory support; E) required vasopressors; F) received thrombolysis; G) had major bleeding; H) returned to the ED; I) died. We enrolled 245 patients with PE. Of these, 115 (47%) were male, 204 (83%) were white. The mean age was 57 ± 17 years. The PESI identified 109 (44%) as low risk and 136 (56%) as high risk. Sixty-one (26%) patients had the outcome, of whom nine (14%) were char-acterised as low risk by the PESI. Test characteristics were: sensitivity 86% (95% confidence interval [CI]: 75%-93%), specificity 55% (95% CI: 47%-62%), NPV 63% (95% CI: 55%-70%), PPV 40% (95% CI: 31%-49%), LR(+) 1.9 (95% CI: 1.57–2.30) and LR(-) 0.26 (95% CI: 0.14–0.48). Of the patients categorised by the PESI as safe for discharge, 14% had an adverse clinical event or required a hospital-based intervention within the first five days after PE diagnosis. Improvements in the risk stratification of patients with PE are still needed.* Presented at the American College of Emergency Physicians, Scientific Assembly, Boston, 2009.

Comparison of Different Clinical Prognostic Scores in Patients with Pulmonary Embolism and Active Cancer

2021 ◽  
Author(s):  
Xiao-qian Li ◽  
Yue-hong Hu ◽  
Ping Lin ◽  
Jia-Rui Zhang ◽  
Yong-jiang Tang ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Roc Curve ◽  
Predictive Performance ◽  
Adverse Outcomes ◽  
Low Risk ◽  
Prognostic Scores ◽  
Roc Curve Analysis ◽  
Risk Patients ◽  
Active Cancer ◽  
Overall Mortality

Objective: To validate and compare the prognostic performance of generic scores (PESI and Hestia) and cancer-specific pulmonary embolism (PE)/venous thromboembolism (VTE) scales (RIETE, POMPE-C and modified Ottawa) in PE patients with active cancer. Methods: A retrospective study was conducted among 460 patients with PE and active cancer. The primary outcome was 30-day overall mortality. Secondary outcomes were 30-day PE-related death and overall adverse outcomes. The prognostic accuracy of clinical scores was determined using receiver operating characteristic (ROC) curve analysis. Results: 18.0% of patients died within 30 days, 2.0% suffered major bleeding and 0.2% presented recurrence of VTE. All scales showed a high area under the ROC curve (AUC) for predicting 30-day overall mortality except modified Ottawa [0.74 (0.70-0.78) for PESI, Hestia and RIETE, 0.78 (0.74-0.81) for POMPE-C, 0.64 (0.59-0.68) for modified Ottawa]. PESI divided the least patients (9.1%) into low risk, followed by modified Ottawa (17.0%). Hestia stratified the most patients (65.4%) as low risk. But overall mortality of low-risk patients based on these three scales are high (>5%). RIETE and POMPE-C both classified 30.9% patients as low risk and low-risk patients stratified by these two scales presented a low overall mortality (1.4% and 3.5%). Similar predictive performance were found for 30-day PE-related death and overall adverse outcomes in these scores. Conclusions: Cancer-specific PE prognostic scores (RIETE and POMPE-C) performed better than generic scales (PESI and Hestia) and a cancer-specific VTE prognostic scale (modified Ottawa) in identifying low-risk PE patients with active cancer who may be suitable for outpatient treatment.

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