Simplification of the Pulmonary Embolism Severity Index for Prognostication in Patients With Acute Symptomatic Pulmonary Embolism

Jiménez, David; Aujesky, Drahomir; Moores, Lisa K.; Gómez, Vicente; Lobo, José Luís; Uresandi, Fernando; Otero, Remedios; Monreal, Manuel; Muriel, Alfonso; Yusen, Roger D.

doi:10.1001/archinternmed.2010.199

Cited by 1,082 publications

(869 citation statements)

References 26 publications

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“…3 Certain ECG characteristics have been shown to be associated with RHS but typically are not incorporated in the risk-stratification models. 4,16 In this study, we found 3 ECG characteristics independently associated with RHS: TWI in leads V 1 through V 3 , S wave in lead I, and sinus tachycardia. We derived a simple, easyto-use, 10-point ECG score that can effectively risk-stratify 85% of acute PE patients.…”

Section: Discussionsupporting

confidence: 49%

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Association Between Electrocardiographic Findings, Right Heart Strain, and Short‐Term Adverse Clinical Events in Patients With Acute Pulmonary Embolism

Hariharan

Dudzinski

Okechukwu

et al. 2015

Clinical Cardiology

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Background: Electrocardiographic (ECG) changes may be seen with pulmonary emboli (PE). Whether ECG is associated with short-term adverse clinical events after PE is less well established. Hypothesis: ECG findings are associated with short-term clinical deterioration after PE. Methods: Consecutive adult PE patients were enrolled in an academic emergency department from 2008 to 2011. The primary outcome was right heart strain (RHS) on echocardiogram or CT pulmonary angiography, or TnT ≥0.1 ng/mL. We derived an ECG (TwiST) score that is associated with RHS and short-term adverse clinical events. Results: We enrolled 298 patients with PE. On multivariate analysis, T-wave inversion in leads V 1 through V 3 (OR: 4.7, 95% confidence interval [CI]: 1.7-13.2), S wave in lead I (OR: 2.0, 95% CI: 1.1-3.5), and tachycardia (OR: 2.5, 95% CI: 1.3-4.8) were associated with RHS. A TwiST score ≤2 (n = 210, 72%) was 84% (95% CI: 77%-90%) sensitive for the absence of RHS, whereas a TwiST score ≥5 (n = 47, 16%) was 93% (95% CI: 88%-97%) specific for the presence of RHS. Conclusions: A simple ECG (TwiST) score can identify patients likely or not likely to have RHS with >80% specificity and sensitivity and may assist in identifying patients with acute PE at risk for adverse clinical events before pursuing other advanced imaging tests.

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Section: Discussionsupporting

confidence: 49%

“…15 This timeframe was chosen based on prior literature and is consistent with a typical length of hospitalization for PE. 16 …”

Section: Secondary Outcome and Subanalysismentioning

confidence: 99%

Association Between Electrocardiographic Findings, Right Heart Strain, and Short‐Term Adverse Clinical Events in Patients With Acute Pulmonary Embolism

Hariharan

Dudzinski

Okechukwu

et al. 2015

Clinical Cardiology

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“…Similar to the above parameters, PESI score was initially devised to predict mortality and to identify low-risk patients who may be candidates for outpatient treatment or abbreviated hospital stay [16]. sPESI, with similar prognostic accuracy, reduces complexity by including 6 of the 11 original PESI variables [7], and we aimed to analyze the usefulness of PESI and sPESI scores to predict LOS in normotensive patients with acute PE. Our investigation showed that a PESI score of <85 points and a sPESI score of 0 (low-risk class) identified patients at low risk and accurately predicted short LOS.…”

Section: Discussionmentioning

confidence: 99%

Predictors of hospital stay in normotensive acute pulmonary embolism: a retrospective pilot study

Mukhtar

Alhafidh

Khalid

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

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Introduction: The aim of our study is to determine the clinical, biochemical, and imaging factors that affect the duration of hospital stay in patients admitted with normotensive acute pulmonary embolism.Methods: This was a single-center retrospective study conducted in a community hospital in New York metropolitan area for patients admitted from October 2015 to October 2017.Results: A total of 79 patients were included, the mean age was 55.76 (SD = 17.33), 29 cases were males (37%) and 50 cases were females (63%). Among all patients, 17 cases had short length of stay (LOS) (≤2 days) and 62 cases had long LOS (>2 days). There were statistically significant differences in age (p = .041), presence of lung disease (p = .036), number of comorbidities (p = .043), and pulmonary embolism severity index (PESI) scores (original and simplified; p = .002 and .001, respectively). Logistic regression analysis showed that PESI score significantly predicted long LOS (OR 1.067, 95% CI [1.001, 1.137], p = .048). Similarly, sPESI significantly predicted long LOS (OR 0.223, 95% CI [0.050, 0.999], p = .050). Both regression models were adjusted for age, lung disease, and number of comorbidities.Conclusion: Both original and simplified PESI scores were statistically significant predictors of duration of hospital stay. Patients with multiple comorbidities or with chronic lung disease were also likely to have prolonged hospital stay. None of the cardiac biomarkers affected the duration of hospital stay, neither did the presence of right ventricular dysfunction nor treatment modality.

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“…For this study, we included patients with acute symptomatic PE from March 2001 to July 2017. We compared the demographics, comorbidities (such as underlying coronary disease, heart failure, and atrial fibrillation) as well as the baseline simplified PE severity index (sPESI)8 and PESI9 in PE patients with versus those without early TTE. We used a generalized linear mixed model, with random effect for enrolling centers, to determine significant predictors of early TTE.…”

Section: Methodsmentioning

confidence: 99%

Early Use of Echocardiography in Patients With Acute Pulmonary Embolism: Findings From the RIETE Registry

Bikdeli

Lobo

Jiménez

et al. 2018

JAHA

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BackgroundTransthoracic echocardiography (TTE) is often considered for risk stratification of patients with acute pulmonary embolism (PE). We sought to determine the contemporary utilization of early TTE (within 72 hours of PE diagnosis) and explored the association between TTE findings and PE‐related mortality.Methods and ResultsData from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry, a multicenter registry of consecutive patients with acute PE, were used (2001–July 2017). We used a generalized linear mixed model to determine predictors of early TTE performance. Moreover, the association between 3 TTE variables (right atrial enlargement, right ventricular hypokinesis, and presence of right heart thrombi) and 30‐day PE‐related mortality was assessed in generalized linear mixed models adjusted for PE severity index, and other comorbidities. Among 35 935 enrollees with acute PE, 15 375 (42.8%) underwent early TTE. There was an increase in early TTE utilization rate over time (P<0.001 for trend). Younger age, female sex, enrollment in countries other than Spain, history of coronary disease, heart failure, atrial fibrillation, tachycardia, and hypotension were the main predictors of early TTE (P<0.01 for all). In multivariable analyses, right atrial enlargement (adjusted odds ratio: 3.74; 95% confidence interval, 2.10–6.66), right ventricular hypokinesis (adjusted odds ratio: 3.11, 95% confidence interval: 1.85–5.21) and right heart thrombi (adjusted odds ratio: 4.39, 95% confidence interval, 1.99–9.71) were associated with increased odds for PE‐related mortality.ConclusionsEarly TTE is commonly performed for acute PE and utilization rates have increased over time. Right atrial enlargement, right ventricular hypokinesis, and right heart thrombi are predictive of worse outcomes.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02832245.

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Simplification of the Pulmonary Embolism Severity Index for Prognostication in Patients With Acute Symptomatic Pulmonary Embolism

Abstract: The simplified PESI has similar prognostic accuracy and clinical utility and greater ease of use compared with the original PESI.

Cited by 1,082 publications

References 26 publications

Association Between Electrocardiographic Findings, Right Heart Strain, and Short‐Term Adverse Clinical Events in Patients With Acute Pulmonary Embolism

Association Between Electrocardiographic Findings, Right Heart Strain, and Short‐Term Adverse Clinical Events in Patients With Acute Pulmonary Embolism

Predictors of hospital stay in normotensive acute pulmonary embolism: a retrospective pilot study

Early Use of Echocardiography in Patients With Acute Pulmonary Embolism: Findings From the RIETE Registry

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