Prognostic Accuracy of Clinical Prediction Rules for Early Post-Pulmonary Embolism All-Cause Mortality

Risk Stratification of Patients With Acute Symptomatic Pulmonary Embolism Based on Presence or Absence of Lower Extremity DVT

“…Predictive clinical models (e.g., sPESI, PESI) that do not utilize CUS have also repeatedly shown a high negative predictive value for allcause mortality, and they may accurately identify low-risk patients with confirmed PE who might be candidates for partial or complete outpatient treatment (36). The design of this meta-analysis did not allow to test whether or not venous CUS of the lower extremities (i.e., to exclude concomitant DVT) could potentially improve the accuracy of clinical prediction rules for the identification of low-risk patients for outpatient management.…”

Pulmonary embolism: whom to discharge and whom to thrombolyze?

“…The risk of death varies between 0% and 5.6% in patients classified as low risk by the 'ESC score' and between 2.5% and 22.5% in those at intermediate risk [11].…”

“…The FAST score combines heart-type fatty acid binding protein (H-FABP) (≥ 6 ng mL À1 ), heart rate (> 110 bpm), and syncope [18]. In normotensive patients with PE, the positive predictive value of the FAST score and sPESI for PE-related complications were 22% (95% CI, [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] and 11% (95% CI, [8][9][10][11][12][13][14][15][16][17], respectively [18]. Combining patient data from six studies involving 2874 normotensive patients with PE, Bova et al developed a prognostic model for intermediate-risk PE.…”

“…The Hestia criteria and the sPESI classified different patients eligible for outpatient treatment, with similar and low mortality rates [22]. Of note, HESTIA and the criteria described by Erkens et al lack external validation yet, whereas PESI and sPESI have been assessed in several independent studies [11].…”

Risk stratification of pulmonary embolism: clinical evaluation, biomarkers or both?

“…Cohort studies and one randomised clinical trial have confirmed that low-risk patients can safely be treated at home [4,5]. Implementing PESI enables the identification of ∼45% of patients with acute PE as low-risk patients and reduces the length of hospitalisation without significantly increasing the risk of death, recurrent PE or major bleeding [4,6]. Patients with normal blood pressure, but higher values of PESI or sPESI, have a mortality risk of ∼5-7% and should be treated at hospital according to ESC guidelines [1,7,8].…”