Pulmonary Vascular Disease |

Performance Characteristics for the Simplified Pulmonary Embolism Severity Index: A Meta-Analysis FREE TO VIEW

Robert Walter*, MD; Aaron Holley, MD
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Walter Reed National Military Medical Center, Bethesda, MD

Chest. 2012;142(4_MeetingAbstracts):849A. doi:10.1378/chest.1390421
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SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters II

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Studies have demonstrated the potential clinical utility of the simplified Pulmonary Embolism Severity Index (sPESI) for risk stratification in patients with acute pulmonary embolism (PE). Authors have suggested the index can be used to triage patients to different levels of care, to include outpatient management. The purpose of our study was to perform a systematic review to confirm that sPESI predicts short-term mortality across different patient populations.

METHODS: A search was performed within MEDLINE and EMBASE to identify both prospective and retrospective trials that enrolled patients with acute PE who were risk stratified utilizing the sPESI. Two independent investigators employed standardized criteria to review articles for inclusion and data extraction. Rates of all-cause and pulmonary embolism-specific mortality were examined at available time points (14 days, 30 days, and 3 months).

RESULTS: Of the 169 articles initially reviewed, 7 were selected for full review (total of 25,814 patients). Specific time points were analyzed if there were > 2 studies with similar data points. For all-cause mortality at 30 days, the sPESI demonstrated a mean sensitivity, specificity, positive and negative likelihood ratio of 94% (95% CI: 0.91 - 0.96), 36% (95% CI: 0.33 - 0.38), 1.5 (95% CI: 1.4 -1.5), and 0.18 (95% CI: 0.13 - 0.24), respectively. The Area Under Receiver Operating Characteristic (AUROC) curve was 0.57 (95% CI: 0.52 - 0.61).

CONCLUSIONS: The sPESI has an excellent sensitivity and negative likelihood ratio for predicting 30-day mortality. It should be evaluated in outcome studies, where patients with a low-risk score are treated as outpatients. The positive likelihood ratio showed less predictive capacity.

CLINICAL IMPLICATIONS: The sPESI is a useful point-of-care prognostic score that can accurately identify patients at low risk for death.

DISCLOSURE: The following authors have nothing to disclose: Robert Walter, Aaron Holley

No Product/Research Disclosure Information

Walter Reed National Military Medical Center, Bethesda, MD




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