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Correspondence |

Prognostic Scores in Pulmonary EmbolismPrognostic Scores in Pulmonary Embolism FREE TO VIEW

Suman B. Thapamagar, MBBS; Ramya Mallareddy, MD
Author and Funding Information

From the Internal Medicine Residency Program, Easton Hospital.

Correspondence to: Suman B. Thapamagar, MBBS, Internal Medicine Residency Program, Easton Hospital, 250 S 21st St, Easton, PA 18042; e-mail: sthapamagar@gmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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Chest. 2013;143(3):872-873. doi:10.1378/chest.12-2515
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To the Editor:

We reviewed the article published in CHEST (April 2012) by Lankeit et al1 during our monthly journal club. The authors have done an impressive job of assessing the performance of the two prognostic models for pulmonary embolism in predicting short-term mortality: the European Society of Cardiology (ESC) model and the simplified Pulmonary Embolism Severity Index.

While reviewing this article, we came across a few contradicting data. In the “Results” section, while reporting secondary outcomes, the authors mentioned that secondary end points occurred in 1.8% (95% CI, 0.2-3.9%) of the simplified Pulmonary Embolism Severity Index low-risk strata and 5.8% (95% CI, 2.6-9.0%) of the ESC low-risk strata with a difference of 4.0% points (95% CI, 0.2-7.8).

However, in Table 4, which is the corresponding table for both primary and secondary outcome, the percentage of patients who met secondary end points in low-risk ESC model strata is reported as 2.4% (95% CI, 0.3-4.5), which is different from the percentage reported in the text. To evaluate this discrepancy, we took the liberty of editing Table 4 to make it more illustrative (Table 1). In this table, we can clearly see that if we accept the secondary end point rate for the ESC model as such, the total number of secondary end points is 21, which is the reported total number of secondary end points in the study. But, if we accept the secondary end point rate of 5.8% for low-risk ESC model strata, then the total number of patients meeting this end point for low-risk ESC model strata would be 12 and total number of secondary end point events for the ESC model would be 28 (low-risk strata =12 and elevated-risk strata =16) (Table 2), which is incorrect according to the reported events in the study.

Table Graphic Jump Location
Table 1 —Thirty-Day Mortality and Nonfatal Adverse Events Based on the sPESI and the ESC Prognostic Model (Reformatted From the Original Lankeit et al1 Table 4)

Data given as % (95% CI) unless otherwise indicated. ESC = European Society of Cardiology; sPESI = simplified Pulmonary Embolism Severity Index.

Table Graphic Jump Location
Table 2 —Thirty-Day Mortality and Nonfatal Adverse Events Based on the ESC Prognostic Model (Accepting a Secondary End Point Event Rate of 5.8% for Low-risk Strata)

Data given as % (95% CI) unless otherwise indicated. See Table 1 legend for expansion of abbreviations.

In the absence of the raw data, we are not in the position to make the final evaluation of this discrepancy. Therefore, it would be helpful if the authors could elaborate on these data and indicate the effects on secondary end points if it was incorrectly reported.

References

Lankeit M, Gómez V, Wagner C, et al; on behalf of the Instituto Ramón y Cajal de Investigación Sanitaria Pulmonary Embolism Study Group. A strategy combining imaging and laboratory biomarkers in comparison with a simplified clinical score for risk stratification of patients with acute pulmonary embolism. Chest. 2012;141(4):916-922. [CrossRef] [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1 —Thirty-Day Mortality and Nonfatal Adverse Events Based on the sPESI and the ESC Prognostic Model (Reformatted From the Original Lankeit et al1 Table 4)

Data given as % (95% CI) unless otherwise indicated. ESC = European Society of Cardiology; sPESI = simplified Pulmonary Embolism Severity Index.

Table Graphic Jump Location
Table 2 —Thirty-Day Mortality and Nonfatal Adverse Events Based on the ESC Prognostic Model (Accepting a Secondary End Point Event Rate of 5.8% for Low-risk Strata)

Data given as % (95% CI) unless otherwise indicated. See Table 1 legend for expansion of abbreviations.

References

Lankeit M, Gómez V, Wagner C, et al; on behalf of the Instituto Ramón y Cajal de Investigación Sanitaria Pulmonary Embolism Study Group. A strategy combining imaging and laboratory biomarkers in comparison with a simplified clinical score for risk stratification of patients with acute pulmonary embolism. Chest. 2012;141(4):916-922. [CrossRef] [PubMed]
 
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