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29-07-2010 | Cardiology | Article

Pulmonary embolism severity index has potential for clinical application

Abstract

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MedWire News: The pulmonary embolism severity index (PESI) is a reproducible and reliable scoring tool to predict both 30- and 90-day mortality in patients with acute pulmonary embolism (PE), US researchers report.

"Rapid, accurate risk stratification is paramount in managing patients with acute PE," say Chee Chan and colleagues from Washington Hospital Center in Washington District of Columbia.

The PESI is a simple tool that risk-stratifies patients with acute PE on the basis of 11 clinical variables, including age, gender, comorbidities, and clinical findings, that can be quickly assessed by the physician without the need for imaging technology or laboratory testing.

To validate the PESI as a predictor of short- and intermediate-term mortality and to determine inter-rater variability, Chan and team conducted a retrospective analysis of 302 patients (mean age 59.7 years, 44% male) diagnosed with acute PE at their hospital.

Two clinicians reviewed patient charts and independently scored PESI blinded to each other's scores and to patient outcomes. The raw PESI scores were then converted into risk class groups (I-V) and further dichotomized into low risk (I-II) and high risk (III-V) groups.

The researchers report that all-cause 30- and 90-day mortalities were 3.0% and 4.0%, respectively. The mortality rate increased as raw PESI score increased and the risk for death correlated with risk class.

There were no deaths in risk classes I-III, but 30- and 90-day mortality for class V was 9.2% and 10.5%, respectively.

Overall, mean PESI scores were similar between observers, and the inter-rater variability, as assessed by the kappa statistic, was good (kappa = 0.69).

The researchers found that direct concordance between the observers improved when the PESI scores were converted into class stratification. This suggests that risk class rather than raw score seems to be the more appropriate classification method for mortality assessment, they say.

"The PESI has much potential for clinical application both at the bedside and in clinical trials," conclude Chan and co-authors in the Journal of Thrombosis and Haemostasis."

"However, further studies are required to properly identify patients who can be discharged early for outpatient management," they say.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Laura Dean

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