Pulmonary Embolism Risk Stratification: Pulse Oximetry and Pulmonary Embolism Severity Index

Nordenholz, Kristen E.; Ryan, Jordan; Atwood, Benjamin; Heard, Kennon

doi:10.1016/j.jemermed.2009.06.004

Cited by 16 publications

(13 citation statements)

References 15 publications

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“…Data were prospectively collected in 25 cohorts (67.6%). Only six (18.9%) manuscripts reported a detailed description of patient treatment [15,22,23,26,34,41,46]. All studies included patients with radiologically proven PE, except two studies in which a ICD-9 code was the only criteria for identifying patients with PE [17,29].…”

Section: Study Qualitymentioning

confidence: 99%

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

Squizzato

Donadini

Galli

et al. 2012

Journal of Thrombosis and Haemostasis

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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.

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Section: Study Qualitymentioning

confidence: 99%

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

Squizzato

Donadini

Galli

et al. 2012

Journal of Thrombosis and Haemostasis

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“…There have been numerous studies with conflicting findings on the predictive value of SpO 2 in adult and pediatric populations. [4][5][6][7][8][9] While there are limited data related to a normal range in pregnancy against which to measure physiological perturbations, a suggested normal value for SpO 2 in pregnancy is ≥ 97%. 10 The ability of maternal SpO 2 to predict adverse maternal outcomes has been poorly studied, and in the few studies of the subject the definitions of oxygen desaturation events are inconsistent.…”

Section: Introductionmentioning

confidence: 99%

Oxygen Saturation as a Predictor of Adverse Maternal Outcomes in Women with Preeclampsia

Millman

Payne

et al. 2011

Journal of Obstetrics and Gynaecology Canada

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Objective: We sought to determine the role of respiratory assessment by cardiorespiratory symptoms and/or oxygen saturation by pulse oximetry (SpO 2 ) in predicting adverse maternal outcomes in women admitted to hospital with preeclampsia .Methods: These data derive from an international, prospective multicentre cohort study, PIERS (Pre-eclampsia Integrated Estimate of RiSk), which assesses predictors of adverse outcomes in women admitted to tertiary perinatal units with preeclampsia . Univariate and multivariate analyses of cardiorespiratory symptoms and pulse oximetry were performed to assess their ability to predict a combined adverse maternal outcome developed through international Delphi consensus .Results: SpO 2 successfully predicted adverse maternal outcomes; the area under the receiver-operator characteristic curve (AUC ROC) was 0 .71 (95% CI 0 .65 to 0 .77) . Combining the symptoms of chest pain and/or dyspnea with pulse oximetry improved this predictive ability (AUC ROC 0 .73; 95% CI 0 .67 to 0 .78) . When SpO 2 was stratified into risk groups using inflection points on the ROC curve, the highest risk group (SpO 2 90% to 93%) had an odds ratio of 18 .1 (95% CI 8 .2 to 40 .2) for all outcomes within 48 hours when compared with the baseline group (SpO 2 98% to 100%) . Conclusion:Assessing SpO 2 aids in the assessment of maternal risk in women admitted to hospital with preeclampsia . An SpO 2 value of ≤ 93% confers particular risk . The symptom complex of chest pain and/or dyspnea adds to the association . RésuméObjectif : Nous avons cherché à déterminer le rôle de l'évaluation respiratoire en fonction des symptômes cardiorespiratoires et/ou celui de la détermination de la saturation en oxygène par oxymétrie pulsée (SaO 2 ) dans la prédiction des issues maternelles indésirables chez les femmes hospitalisées en raison d'une prééclampsie . Méthodes :Ces données sont issues de l'étude de cohorte multicentrique prospective internationale PIERS (Pre-eclampsia Integrated Estimate of RiSk), laquelle a évalué les facteurs prédictifs des issues indésirables chez les femmes admises dans des unités périnatales tertiaires en raison d'une prééclampsie . Des analyses univariées et multivariées des symptômes cardiorespiratoires et de l'oxymétrie pulsée ont été menées pour en évaluer la capacité de prédire une issue maternelle indésirable combinée, élaborée par consensus Delphi international .Résultats : La SaO 2 a permis de prédire avec succès les issues maternelles indésirables; la surface sous la courbe de la fonction d'efficacité de l'observateur-opérateur (AUC ROC) était de 0,71 (IC à 95 %, 0,65 -0,77) . Le fait de combiner les symptômes de la douleur thoracique et/ou de la dyspnée à l'oxymétrie pulsée a entraîné l'amélioration de cette capacité de prédiction (AUC ROC, 0,73; IC à 95 %, 0,78

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“…12,13,16 The reliability of saturation has been investigated for many diseases. 20 Additionally, the British Thoracic Society guidelines recommend a target SaO 2 (SpO 2 ) above 94% for hypoxemic patients, including PE patients, to ensure that actual oxygen levels remain above 90% for most of the time. Additionally, upon reaching 60 mmHg, the target SpO 2 should be 92% for white patients and higher for black patients.…”

Section: Discussionmentioning

confidence: 99%

Is oxygen saturation variable of simplified pulmonary embolism severity index reliable for identification of patients, suitable for outpatient treatment

Erol

Kaya

Ciftci

et al. 2016

Clinical Respiratory J

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Pulmonary Embolism Risk Stratification: Pulse Oximetry and Pulmonary Embolism Severity Index

Abstract: Background-Risk stratification of pulmonary embolism (PE) patients is important to determine appropriate management.

Cited by 16 publications

References 15 publications

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

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

Oxygen Saturation as a Predictor of Adverse Maternal Outcomes in Women with Preeclampsia

Is oxygen saturation variable of simplified pulmonary embolism severity index reliable for identification of patients, suitable for outpatient treatment

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