David R Vinson1, Dustin W Ballard2, Dustin G Mark3, Jie Huang4, Mary E Reed4, Adina S Rauchwerger4, David H Wang5, James S Lin6, Mamata V Kene7, Tamara S Pleshakov8, Dana K Sax3, Jordan M Sax9, D Ian McLachlan10, Cyrus K Yamin11, Clifford J Swap12, Hilary R Iskin13, Ridhima Vemula14, Bethany S Fleming15, Andrew R Elms16, Drahomir Aujesky17. 1. The Permanente Medical Group, Oakland, California, United States; Kaiser Permanente Northern California Division of Research, Oakland, California, United States; Department of Emergency Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, California, United States. Electronic address: drvinson@ucdavis.edu. 2. The Permanente Medical Group, Oakland, California, United States; Kaiser Permanente Northern California Division of Research, Oakland, California, United States; Department of Emergency Medicine, Kaiser Permanente San Rafael Medical Center, San Rafael, California, United States. 3. The Permanente Medical Group, Oakland, California, United States; Department of Emergency Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California, United States. 4. Kaiser Permanente Northern California Division of Research, Oakland, California, United States. 5. The Permanente Medical Group, Oakland, California, United States; Division of Palliative Care, University of California, San Francisco, San Francisco, California, United States. 6. The Permanente Medical Group, Oakland, California, United States; Department of Emergency Medicine, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California, United States. 7. The Permanente Medical Group, Oakland, California, United States; Department of Emergency Medicine, Kaiser Permanente San Leandro Medical Center, San Leandro, California, United States. 8. Department of Emergency Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, United States. 9. The Permanente Medical Group, Oakland, California, United States; Department of Emergency Medicine, Kaiser Permanente San Rafael Medical Center, San Rafael, California, United States. 10. The Permanente Medical Group, Oakland, California, United States; Department of Emergency Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, United States. 11. The Permanente Medical Group, Oakland, California, United States; Kaiser Permanente Northern California Division of Research, Oakland, California, United States; Department of Emergency Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California, United States. 12. Department of Emergency Medicine, Kaiser Permanente San Diego Medical Center, San Diego, California, United States. 13. University of Michigan Medical School, Ann Arbor, MI, United States. 14. University of Cincinnati College of Medicine, Cincinnati, OH, United States. 15. The Permanente Medical Group, Oakland, California, United States; Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, Roseville, California, United States. 16. The Permanente Medical Group, Oakland, California, United States; Department of Emergency Medicine, Kaiser Permanente South Sacramento Medical Center, Sacramento, California, United States. 17. Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
Abstract
INTRODUCTION: The Pulmonary Embolism Severity Index (PESI) is a validated prognostic score to estimate the 30-day mortality of emergency department (ED) patients with acute pulmonary embolism (PE). A simplified version (sPESI) was derived but has not been as well studied in the U.S. We sought to validate both indices in a community hospital setting in the U.S. and compare their performance in predicting 30-day all-cause mortality and classification of cases into low-risk and higher-risk categories. MATERIALS AND METHODS: This retrospective cohort study included adults with acute objectively confirmed PE from 1/2013 to 4/2015 across 21 community EDs. We evaluated the misclassification rate of the sPESI compared with the PESI. We assessed accuracy of both indices with regard to 30-day mortality. RESULTS: Among 3006 cases of acute PE, the 30-day all-cause mortality rate was 4.4%. The sPESI performed as well as the PESI in identifying low-risk patients: both had similar sensitivities, negative predictive values, and negative likelihood ratios. The sPESI, however, classified a smaller proportion of patients as low risk than the PESI (27.5% vs. 41.0%), but with similar low-risk mortality rates (<1%). Compared with the PESI, the sPESI overclassified 443 low-risk patients (14.7%) as higher risk, yet their 30-day mortality was 0.7%. The sPESI underclassified 100 higher-risk patients (3.3%) as low risk who also had a low mortality rate (1.0%). CONCLUSIONS: Both indices identified patients with PE who were at low risk for 30-day mortality. The sPESI, however, misclassified a significant number of low-mortality patients as higher risk, which could lead to unnecessary hospitalizations.
INTRODUCTION: The Pulmonary Embolism Severity Index (PESI) is a validated prognostic score to estimate the 30-day mortality of emergency department (ED) patients with acute pulmonary embolism (PE). A simplified version (sPESI) was derived but has not been as well studied in the U.S. We sought to validate both indices in a community hospital setting in the U.S. and compare their performance in predicting 30-day all-cause mortality and classification of cases into low-risk and higher-risk categories. MATERIALS AND METHODS: This retrospective cohort study included adults with acute objectively confirmed PE from 1/2013 to 4/2015 across 21 community EDs. We evaluated the misclassification rate of the sPESI compared with the PESI. We assessed accuracy of both indices with regard to 30-day mortality. RESULTS: Among 3006 cases of acute PE, the 30-day all-cause mortality rate was 4.4%. The sPESI performed as well as the PESI in identifying low-risk patients: both had similar sensitivities, negative predictive values, and negative likelihood ratios. The sPESI, however, classified a smaller proportion of patients as low risk than the PESI (27.5% vs. 41.0%), but with similar low-risk mortality rates (<1%). Compared with the PESI, the sPESI overclassified 443 low-risk patients (14.7%) as higher risk, yet their 30-day mortality was 0.7%. The sPESI underclassified 100 higher-risk patients (3.3%) as low risk who also had a low mortality rate (1.0%). CONCLUSIONS: Both indices identified patients with PE who were at low risk for 30-day mortality. The sPESI, however, misclassified a significant number of low-mortality patients as higher risk, which could lead to unnecessary hospitalizations.
Authors: Laura E Simon; Adina S Rauchwerger; Uli K Chettipally; Leon Babakhanian; David R Vinson; E Margaret Warton; Mary E Reed; Anupam B Kharbanda; Elyse O Kharbanda; Dustin W Ballard Journal: J Am Med Inform Assoc Date: 2019-11-01 Impact factor: 4.497
Authors: Jean-Pierre Iskandar; Essa Hariri; Christopher Kanaan; Nicholas Kassis; Hayaan Kamran; Denise Sese; Colin Wright; Mark Marinescu; Scott J Cameron Journal: J Thromb Thrombolysis Date: 2021-09-29 Impact factor: 2.300
Authors: David R Vinson; Erik R Hofmann; Elizabeth J Johnson; Suresh Rangarajan; Jie Huang; Dayna J Isaacs; Judy Shan; Karen L Wallace; Adina S Rauchwerger; Mary E Reed; Dustin G Mark Journal: J Gen Intern Med Date: 2022-01-12 Impact factor: 6.473
Authors: Laura E Simon; Mamata V Kene; E Margaret Warton; Adina S Rauchwerger; David R Vinson; Mary E Reed; Uli K Chettipally; Dustin G Mark; Dana R Sax; D Ian McLachlan; Dale M Cotton; James S Lin; Gabriela Vazquez-Benitez; Anupam B Kharbanda; Elyse O Kharbanda; Dustin W Ballard Journal: Acad Emerg Med Date: 2020-04-02 Impact factor: 3.451
Authors: Laura E Simon; Hilary R Iskin; Ridhima Vemula; Jie Huang; Adina S Rauchwerger; Mary E Reed; Dustin W Ballard; David R Vinson Journal: West J Emerg Med Date: 2018-10-18
Authors: Michelle Y Liu; Dustin W Ballard; Jie Huang; Adina S Rauchwerger; Mary E Reed; Sean C Bouvet; David R Vinson Journal: West J Emerg Med Date: 2018-04-06