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Comparing predictive performance of pulmonary embolism risk stratification tools for acute clinical deterioration
OBJECTIVES: Existing pulmonary embolism (PE) risk scores were developed to predict death within weeks, but not more proximate adverse events. We determined the ability of 3 PE risk stratification tools (simplified pulmonary embolism severity index [sPESI], 2019 European Society of Cardiology guideli...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10214857/ https://www.ncbi.nlm.nih.gov/pubmed/37251351 http://dx.doi.org/10.1002/emp2.12983 |
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author | Weekes, Anthony J. Raper, Jaron D. Esener, Dasia Davison, Jillian Boyd, Jeremy S. Kelly, Christopher Nomura, Jason T. Thomas, Alyssa M. Lupez, Kathryn Cox, Carly A. Ockerse, Patrick M. Leech, Stephen Johnson, Jakea Abrams, Eric Murphy, Kathleen O'Connell, Nathaniel S. |
author_facet | Weekes, Anthony J. Raper, Jaron D. Esener, Dasia Davison, Jillian Boyd, Jeremy S. Kelly, Christopher Nomura, Jason T. Thomas, Alyssa M. Lupez, Kathryn Cox, Carly A. Ockerse, Patrick M. Leech, Stephen Johnson, Jakea Abrams, Eric Murphy, Kathleen O'Connell, Nathaniel S. |
author_sort | Weekes, Anthony J. |
collection | PubMed |
description | OBJECTIVES: Existing pulmonary embolism (PE) risk scores were developed to predict death within weeks, but not more proximate adverse events. We determined the ability of 3 PE risk stratification tools (simplified pulmonary embolism severity index [sPESI], 2019 European Society of Cardiology guidelines [ESC], and PE short‐term clinical outcomes risk estimation [PE‐SCORE]) to predict 5‐day clinical deterioration after emergency department (ED) diagnosis of PE. METHODS: We analyzed data from six EDs on ED patients with confirmed PE. Clinical deterioration was defined as death, respiratory failure, cardiac arrest, new dysrhythmia, sustained hypotension requiring vasopressors or volume resuscitation, or escalated intervention within 5 days of PE diagnosis. We determined sensitivity and specificity of sPESI, ESC, and PE‐SCORE for predicting clinical deterioration. RESULTS: Of 1569 patients, 24.5% had clinical deterioration within 5 days. sPESI, ESC, and PE‐SCORE classifications were low‐risk in 558 (35.6%), 167 (10.6%), and 309 (19.6%), respectively. Sensitivities of sPESI, ESC, and PE‐SCORE for clinical deterioration were 81.8 (78, 85.7), 98.7 (97.6, 99.8), and 96.1 (94.2, 98), respectively. Specificities of sPESI, ESC, and PE‐SCORE for clinical deterioration were 41.2 (38.4, 44), 13.7 (11.7, 15.6), and 24.8 (22.4, 27.3). Areas under the curve were 61.5 (59.1, 63.9), 56.2 (55.1, 57.3), and 60.5 (58.9, 62.0). Negative predictive values were 87.5 (84.7, 90.2), 97 (94.4, 99.6), and 95.1 (92.7, 97.5). CONCLUSIONS: ESC and PE‐SCORE were better than sPESI for detecting clinical deterioration within 5 days after PE diagnosis. |
format | Online Article Text |
id | pubmed-10214857 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-102148572023-05-27 Comparing predictive performance of pulmonary embolism risk stratification tools for acute clinical deterioration Weekes, Anthony J. Raper, Jaron D. Esener, Dasia Davison, Jillian Boyd, Jeremy S. Kelly, Christopher Nomura, Jason T. Thomas, Alyssa M. Lupez, Kathryn Cox, Carly A. Ockerse, Patrick M. Leech, Stephen Johnson, Jakea Abrams, Eric Murphy, Kathleen O'Connell, Nathaniel S. J Am Coll Emerg Physicians Open General Medicine OBJECTIVES: Existing pulmonary embolism (PE) risk scores were developed to predict death within weeks, but not more proximate adverse events. We determined the ability of 3 PE risk stratification tools (simplified pulmonary embolism severity index [sPESI], 2019 European Society of Cardiology guidelines [ESC], and PE short‐term clinical outcomes risk estimation [PE‐SCORE]) to predict 5‐day clinical deterioration after emergency department (ED) diagnosis of PE. METHODS: We analyzed data from six EDs on ED patients with confirmed PE. Clinical deterioration was defined as death, respiratory failure, cardiac arrest, new dysrhythmia, sustained hypotension requiring vasopressors or volume resuscitation, or escalated intervention within 5 days of PE diagnosis. We determined sensitivity and specificity of sPESI, ESC, and PE‐SCORE for predicting clinical deterioration. RESULTS: Of 1569 patients, 24.5% had clinical deterioration within 5 days. sPESI, ESC, and PE‐SCORE classifications were low‐risk in 558 (35.6%), 167 (10.6%), and 309 (19.6%), respectively. Sensitivities of sPESI, ESC, and PE‐SCORE for clinical deterioration were 81.8 (78, 85.7), 98.7 (97.6, 99.8), and 96.1 (94.2, 98), respectively. Specificities of sPESI, ESC, and PE‐SCORE for clinical deterioration were 41.2 (38.4, 44), 13.7 (11.7, 15.6), and 24.8 (22.4, 27.3). Areas under the curve were 61.5 (59.1, 63.9), 56.2 (55.1, 57.3), and 60.5 (58.9, 62.0). Negative predictive values were 87.5 (84.7, 90.2), 97 (94.4, 99.6), and 95.1 (92.7, 97.5). CONCLUSIONS: ESC and PE‐SCORE were better than sPESI for detecting clinical deterioration within 5 days after PE diagnosis. John Wiley and Sons Inc. 2023-05-26 /pmc/articles/PMC10214857/ /pubmed/37251351 http://dx.doi.org/10.1002/emp2.12983 Text en © 2023 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | General Medicine Weekes, Anthony J. Raper, Jaron D. Esener, Dasia Davison, Jillian Boyd, Jeremy S. Kelly, Christopher Nomura, Jason T. Thomas, Alyssa M. Lupez, Kathryn Cox, Carly A. Ockerse, Patrick M. Leech, Stephen Johnson, Jakea Abrams, Eric Murphy, Kathleen O'Connell, Nathaniel S. Comparing predictive performance of pulmonary embolism risk stratification tools for acute clinical deterioration |
title | Comparing predictive performance of pulmonary embolism risk stratification tools for acute clinical deterioration |
title_full | Comparing predictive performance of pulmonary embolism risk stratification tools for acute clinical deterioration |
title_fullStr | Comparing predictive performance of pulmonary embolism risk stratification tools for acute clinical deterioration |
title_full_unstemmed | Comparing predictive performance of pulmonary embolism risk stratification tools for acute clinical deterioration |
title_short | Comparing predictive performance of pulmonary embolism risk stratification tools for acute clinical deterioration |
title_sort | comparing predictive performance of pulmonary embolism risk stratification tools for acute clinical deterioration |
topic | General Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10214857/ https://www.ncbi.nlm.nih.gov/pubmed/37251351 http://dx.doi.org/10.1002/emp2.12983 |
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