Comparison of 4 Acute Pulmonary Embolism Mortality Risk Scores in Patients Evaluated by Pulmonary Embolism Response Teams

• Type of Material: Article
• Authors: Geoffrey D. Barnes, University of Michigan; Alona Muzikansky, Massachusetts General Hospital; Scott Cameron, Cleveland Clinic; Jay Giri, University of Pennsylvania; Gustavo A. Heresi, Cleveland Clinic; Wissam Jaber, Emory University; Todd Wood, Lancaster General Hospital; Thomas M. Todoran, Medical University of South Carolina; D. Mark Courtney, University of Texas Southwestern Medical Center; Victor Tapson, Cedars Sinai Medical Center; Christopher Kabrhel, Massachusetts General Hospital
• Language: English
• Date: 2020-08-26
• Publisher: American Medical Association
• Publication Version: Final Published Version
• Copyright Statement: © 2020 Barnes GD et al. JAMA Network Open.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1001/jamanetworkopen.2020.10779
• Title of Journal or Parent Work: JAMA Network Open
• Volume: 3
• Issue: 8
• Start Page: e2010779
• End Page: e2010779
• Grant/Funding Information: Dr Cameron was supported by grant K08HL128856 from the National Heart, Lung, and Blood Institute. No external funding specific to this project was used.
• Keywords: Therapy; Science & Technology; Management; General & Internal Medicine; Model; Severity index; Medicine, General & Internal; Validation; Prediction; Organizational survey; Prognostication; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Rehabilitation and Therapy; Biology, Biostatistics; Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery

Abstract

Importance The risk of death from acute pulmonary embolism can range as high as 15%, depending on patient factors at initial presentation. Acute treatment decisions are largely based on an estimate of this mortality risk. Objective To assess the performance of risk assessment scores in a modern, US cohort of patients with acute pulmonary embolism. Design, Setting, and Participants This multicenter cohort study was conducted between October 2016 and October 2017 at 8 hospitals participating in the Pulmonary Embolism Response Team (PERT) Consortium registry. Included patients were adults who presented with acute pulmonary embolism and had sufficient information in the medical record to calculate risk scores. Data analysis was performed from March to May 2020. Main Outcomes and Measures All-cause mortality (7- and 30-day) and associated discrimination were assessed by the area under the receiver operator curve (AUC). Results Among 416 patients with acute pulmonary embolism (mean [SD] age, 61.3 [17.6] years; 207 men [49.8%]), 7-day mortality in the low-risk groups ranged from 1.3% (1 patient) to 3.1% (4 patients), whereas 30-day mortality ranged from 2.6% (1 patient) to 10.2% (13 patients). Among patients in the highest-risk groups, the 7-day mortality ranged from 7.0% (18 patients) to 16.3% (7 patients), whereas 30-day mortality ranged from 14.4% (37 patients) to 26.3% (26 patients). Each of the risk stratification tools had modest discrimination for 7-day mortality (AUC range, 0.616-0.666) with slightly lower discrimination for 30-day mortality (AUC range, 0.550-0.694). Conclusions and Relevance These findings suggest that commonly used risk tools for acute pulmonary embolism have modest estimating ability. Future studies to develop and validate better risk assessment tools are needed.