SESSION TITLE: Pulmonary and Sleep Medicine
SESSION TYPE: Slide Presentation
PRESENTED ON: Saturday, March 22, 2014 at 09:00 AM - 10:00 AM
PURPOSE: To evaluate the comparative validity of four prognostic models: pulmonary embolism severity index (PESI), simplified PESI score, PESI risk classes and shock index, for predicting short-term mortality in acute pulmonary embolism.
METHODS: We conducted a prospective observational cohort study between 2004-2010 in the Sf.Spiridon University Hospital. The PESI and PESI - simplified scores and shock-index were calculated. PESI scores were segregated into risk class (I-V) obtaining PESI classes. Shock index was dichotomized into 0 (for value <1) versus 1 (for value >1) risk groups. We determined the area under Receiver Operating Characteristic curve, the sensitivity, specificity, likelihood ratio (LR+, LR-) and we compare the utility of these scoring tools.
RESULTS: The cohort consisted of 362 subjects. The in-hospital mortality was 21.54%. The sensitivity, specificity and likelihood ratios were different for PESI score (43.59, 90.85, 4.76, 0.62), simplified PESI score (92.31, 29.93, 1.32, 0.26), PESI risk classes (35.9, 92.96, 5.10, 0,69) and shock index (43.59, 94.37, 7.74, 0.60), and the area under Receiver Operating Characteristic curve showed values of 0.691 for PESI score, 0.693 for PESI risk classes, 0.623 for PESI score and 0.690 for Shock index (p<0.001).
CONCLUSIONS: The sensitivity, specificity, likelihood ratio were different between scores, but the area under Receiver Operating Characteristic curve showed values in range 0.6-0.7.The assessed prognostic scores performed comparably for identifying pulmonary embolism patients at short-term risk of mortality, even for PESI score segregated in risk classes and dichotomized version of shock index.
CLINICAL IMPLICATIONS: In the development of a clinical prediction rule suitable for use in emergency departments we suggest to include any of these scores that should correlate independently with the prognosis of PE and we consider that the simplified PESI is the most sensitive and easy measurable and the others scores have better specificity.
DISCLOSURE: The following authors have nothing to disclose: Iulia Cristina Roca, Mihai Roca, Carmen Diana Cimpoesu
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