Prognostic clinical prediction rules to identify a low‐risk pulmonary embolism: a systematic review and meta‐analysis

Abstract

To cite this article: Squizzato A, Donadini MP, Galli L, Dentali F, Aujesky D, Ageno W. Prognostic clinical prediction rules to identify a low-risk pulmonary embolism: a systematic review and meta-analysis. J Thromb Haemost 2012; 10: 1276-90.Summary. Background: Prognostic assessment is important for the management of patients with a pulmonary embolism (PE). A number of clinical prediction rules (CPRs) have been proposed for stratifying PE mortality risk. The aim of this systematic review was to assess the performance of prognostic CPRs in identifying a low-risk PE. Methods: MEDLINE and EMBASE databases were systematically searched until August 2011. Derivation and validation studies that assessed the performance of prognostic CPRs in predicting adverse eventsrisk in PE patients were included. Weighted mean proportion and 95% confidence intervals (CIs) of adverse events were then calculated and pooled using a fixed and a random-effects model. Statistical heterogeneity was evaluated through the use of I 2 statistics. Results: Of 1125 references in the original search, 33 relevant articles were included. Nine CPRs were assessed in 37 cohorts, for a total of 35 518 patients. Pulmonary Embolism Severity Index and prognostic Geneva CPR were investigated in 22 and 6 cohorts, respectively. Eleven (29.7%) cohorts were of high quality. The median follow-up was 30 days. In low-risk PE patients, pooled short-term mortality (within 14 days or less) was 0.7% (95% CI 0.3-1.1%, random-effects model; I 2 = 49.6%), 30-day mortality was 1.7% (95% CI 1.1-2.3%, random-effects model; I 2 = 82.4%) and 90-day mortality was 2.2% (95% CI 1.2-3.4%, random-effects model; I 2 = 59.8%). Conclusions: Prognostic CPRs efficiently identify PE patients at a low risk of mortality. Before implementing prognostic CPRs in the routine care of PE patients, welldesigned management studies are warranted.

How to predict short- and long-term mortality in patients with pulmonary embolism?

“…A recent large meta-analysis confirmed the role of the PESI score in the identification of PE patients at a low risk of mortality, 11 and patients with a PESI score of I-II were included in a randomized controlled trial that confirmed the safety and efficacy of home treatment of acute PE. 17 Unfortunately, the PESI score categorizes patients into 5 risk classes and it is not easy to compute.…”

Impact of Relative Contraindications to Home Management in Emergency Department Patients with Low-Risk Pulmonary Embolism

“…Risk stratification tools for emergency department (ED) patients with acute pulmonary embolism (PE) can be used to identify patients at low risk for complications (1). Many of these low-risk patients are eligible for outpatient management (2,3).…”

Cost of Treating Venous Thromboembolism With Heparin and Warfarin Versus Home Treatment With Rivaroxaban

“…While DVT has been treated as an outpatient for many years, recently developed risk stratification tools have been validated to select patients with PE who have a low risk of shortterm complications. [1][2][3][4][5][6][7] In particular, the Hestia criteria identifies a subgroup of PE patients who have a 1.0% mortality rate as outpatients over 3 months and a low rate of short-term complications requiring rehospitalization. 8 In this article, we assumed that many patients with DVT have undiagnosed PE and therefore must undergo the same risk stratification as patients with documented PE.…”