Simplified Tool Assesses Death Risk in Pulmonary Embolism

New Pulmonary Embolism Severity Index has same accuracy, clinical utility as original
By Jeff Muise
HealthDay Reporter

WEDNESDAY, Aug. 11 (HealthDay News) -- A simplified version of the Pulmonary Embolism Severity Index (PESI) has clinical utility and prognostic accuracy that is similar to those of the original index, according to a study published in the Aug. 9/23 issue of the Archives of Internal Medicine.

David Jiménez, M.D., of Hospital Ramón y Cajal in Madrid, Spain, and colleagues developed a simplified PESI clinical prediction rule to estimate 30-day mortality risk in individuals with acute pulmonary embolism. They used a derivation cohort of Spanish outpatients to compare simplified and original PESI performances. They also used an independent multinational cohort of outpatients for retrospective external validation of the simplified PESI.

The researchers found that the simplified PESI retained the variables of age, cancer, chronic cardiopulmonary disease, heart rate, systolic blood pressure, and oxyhemoglobin saturation levels. With the simplified PESI, 30.7 percent of patients were classified as low-risk and had a 30-day mortality of 1.0 percent, while 69.3 percent were high-risk and had a 30-day mortality of 10.9 percent. In the validation group, 36.1 percent were low-risk and had a 30-day mortality of 1.1 percent, compared to 63.9 percent at high-risk with an 8.9 percent 30-day mortality. The authors concluded that the simplified PESI and the original PESI had similar clinical utility and prognostic accuracy but that the simplified tool had greater ease of use.

"The simplified score was not developed to classify patients with pulmonary embolism into categories of increasing risk of mortality. However, the simplified PESI may be a useful tool for identifying patients estimated to be at low risk who could be discharged early or whose pulmonary embolism could be managed entirely in an outpatient setting," the authors write.

The research was supported in part by unrestricted grants from Sanofi-Aventis Spain and by Bayer Schering Pharma.

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