Comparison of two methods for selection of out of hospital treatment in patients with acute pulmonary embolism

  • Zondag W
  • den Exter P
  • Crobach M
 et al. 
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Abstract

The aim of this study is to compare the performance of two clinical decision rules to select patients with acute pulmonary embolism (PE) for outpatient treatment: the Hestia criteria and the simplified Pulmonary Embolism Severity Index (sPESI). From 2008 to 2010, 468 patients with PE were triaged with the Hestia criteria for outpatient treatment: 247 PE patients were treated at home and 221 were treated as inpatients. The outcome of interest was all-cause 30-day mortality. In a post-hoc fashion, the sPESI items were scored and patients were classified according to the sPESI in low and high risk groups. Of the 247 patients treated at home, 189 (77%) patients were classified as low risk according to the sPESI and 58 patients (23%) as high risk. In total, 11 patients died during the first month; two patients treated at home and nine patients treated in-hospital. None of the patients treated at home died of fatal PE. Both the Hestia criteria and sPESI selected >50% of patients as low risk, with good sensitivity and negative predictive values for 30-day mortality: 82% and 99% for the Hestia criteria and 91% and 100% for the sPESI, respectively. The Hestia criteria and the sPESI classified different patients eligible for outpatient treatment, with similar low risks for 30-day mortality. This study suggests that the Hestia criteria may identify a proportion of high risk sPESI patiennts who can be safely treated at home, this however requires further validation

Author-supplied keywords

  • Article
  • HOME
  • LA
  • Netherlands
  • PE
  • PT
  • PULMONARY-EMBOLISM
  • Universities
  • acute
  • acute pulmonary embolism
  • clinical
  • clinical decision rule
  • comparison
  • criteria
  • decision rule
  • embolism
  • fatal
  • fatal PE
  • hemostasis
  • high risk
  • inpatients
  • low risk
  • methods
  • mortality
  • negative predictive value
  • outcome
  • outpatient
  • patient
  • patients
  • performance
  • pulmonary
  • pulmonary embolism
  • risk
  • rule
  • rules
  • study
  • thrombosis
  • treatment
  • validation
  • values

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  • PMID: 23138355

Authors

  • W Zondag

  • P L den Exter

  • M J Crobach

  • A Dolsma

  • M L Donker

  • M Eijsvogel

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