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Original Research: Pulmonary Vascular Disease |

Validation of a Model for Identification of Patients at Intermediate to High Risk for Complications Associated With Acute Symptomatic Pulmonary EmbolismBova Score Validation

Carolina Fernández, MD; Carlo Bova, MD; Olivier Sanchez, PhD; Paolo Prandoni, PhD; Mareike Lankeit, MD; Stavros Konstantinides, PhD; Simone Vanni, MD; Covadonga Fernández-Golfín, PhD; Roger D. Yusen, MD; David Jiménez, PhD, FCCP
Author and Funding Information

From the Respiratory Department (Drs Fernández and Jiménez) and Cardiology Department (Dr Fernández-Golfín), Ramón y Cajal Hospital, IRYCIS, Alcalá de Henares University, Madrid, Spain; Department of Medicine (Dr Bova), University Hospital of Cosenza, Cosenza, Italy; Université Paris Descartes (Dr Sanchez), Sorbonne Paris Cité, Paris, France; Division of Respiratory and Intensive Care Medicine (Dr Sanchez), Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Department of Cardiovascular Sciences (Dr Prandoni), Vascular Medicine Unit, University Hospital of Padua, Padua, Italy; Center for Thrombosis and Hemostasis (Drs Lankeit and Konstantinides), University of Mainz, Mainz, Germany; Emergency Department (Dr Vanni), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Division of Pulmonary and Critical Care Medicine (Dr Yusen), Washington University School of Medicine, St. Louis, MO.

CORRESPONDENCE TO: David Jiménez, PhD, FCCP, Respiratory Department and Medicine Department, Ramón y Cajal Hospital, IRYCIS, Alcalá de Henares University, 28034 Madrid, Spain; e-mail: djimenez.hrc@gmail.com


FUNDING/SUPPORT: The Instituto de Salud Carlos III and NEUMOMADRID provided funding for the study [Grants FIS 2011 (PI11/00246) and NEUMOMADRID 2014].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(1):211-218. doi:10.1378/chest.14-2551
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BACKGROUND:  For patients with acute symptomatic pulmonary embolism (PE), the Bova score classifies their risk for PE-related complications within 30 days after diagnosis. The original Bova score was derived from 2,874 normotensive patients with acute PE who participated in one of six prospective PE studies.

METHODS:  We retrospectively assessed the validity of the Bova risk model in normotensive patients with acute PE diagnosed in an academic urban ED. Two clinician investigators used baseline data for the model’s four prognostic variables to stratify patients into the three Bova risk stages (I-III) for 30-day PE-related complications. Intraclass correlation coefficient (ICC) and the κ statistic were used to assess interrater variability.

RESULTS:  The Bova risk score classified the majority of the cohort of 1,083 patients into the lowest Bova risk stage (stage I, 80%; stage II, 15%; stage III, 5%), The primary end point occurred in 91 of the 1,083 patients (8.4%; 95% CI, 6.7%-10%) during the 30 days after PE diagnosis. Risk stage correlated with the PE-related complication rate (class I, 4.4%; class II, 18%; class III, 42%; ICC, 0.93 [95% CI, 0.92-0.94]; κ statistic, 0.80; P < .001), in-hospital complication rate (class I, 3.7%; class II, 15%; class III, 37%), and 30-day PE-related mortality (class I, 3.1%; class II, 6.8%; class III, 10.5%).

CONCLUSIONS:  The Bova risk score accurately stratifies normotensive patients with acute PE into stages of increasing risk of PE-related complications that occur within 30 days of PE diagnosis.

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