Simplification of the Pulmonary Embolism Severity Index for Prognostication in Patients With Acute Symptomatic Pulmonary Embolism | Pulmonary Medicine | JAMA Internal Medicine | JAMA Network
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Original Investigation
August 9/23, 2010

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

Author Affiliations

Author Affiliations: Respiratory Departments, Hospital Ramón y Cajal, Madrid (Drs Jiménez and Gómez), Txagorritxu Hospital, Vitoria (Dr Lobo), Hospital de Cruces, Vizcaya (Dr Uresandi), and Hospital Universitario Virgen del Rocío, Sevilla (Dr Otero), and Medicine Department, Alcala de Henares University (Dr Jiménez), Spain; Division of General Internal Medicine, University of Lausanne, Lausanne, Switzerland (Dr Aujesky); F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, Maryland (Dr Moores); Department of Medicine Germans Trias I Pujol Hospital, Badalona, Spain (Dr Monreal); Biostatistics Unit, Hospital Ramón y Cajal, Madrid (Mr Muriel); and Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St Louis, Missouri (Dr Yusen).

Arch Intern Med. 2010;170(15):1383-1389. doi:10.1001/archinternmed.2010.199
Abstract

Background  The Pulmonary Embolism Severity Index (PESI) estimates the risk of 30-day mortality in patients with acute pulmonary embolism (PE). We constructed a simplified version of the PESI.

Methods  The study retrospectively developed a simplified PESI clinical prediction rule for estimating the risk of 30-day mortality in a derivation cohort of Spanish outpatients. Simplified and original PESI performances were compared in the derivation cohort. The simplified PESI underwent retrospective external validation in an independent multinational cohort (Registro Informatizado de la Enfermedad Tromboembólica [RIETE] cohort) of outpatients.

Results  In the derivation data set, univariate logistic regression of the original 11 PESI variables led to the removal of variables that did not reach statistical significance and subsequently produced the simplified PESI that contained the variables of age, cancer, chronic cardiopulmonary disease, heart rate, systolic blood pressure, and oxyhemoglobin saturation levels. The prognostic accuracy of the original and simplified PESI scores did not differ (area under the curve, 0.75 [95% confidence interval (CI), 0.69-0.80]). The 305 of 995 patients (30.7%) who were classified as low risk by the simplified PESI had a 30-day mortality of 1.0% (95% CI, 0.0%-2.1%) compared with 10.9% (8.5%-13.2%) in the high-risk group. In the RIETE validation cohort, 2569 of 7106 patients (36.2%) who were classified as low risk by the simplified PESI had a 30-day mortality of 1.1% (95% CI, 0.7%-1.5%) compared with 8.9% (8.1%-9.8%) in the high-risk group.

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

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