This Article Full Text Full Text (PDF) Online Supplement All Versions of this Article: 200506-862OCv1 172/8/1041    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Aujesky, D. Articles by Fine, M. J. Search for Related Content PubMed PubMed Citation Articles by Aujesky, D. Articles by Fine, M. J.

Derivation and Validation of a Prognostic Model for Pulmonary Embolism

Division of General Internal Medicine, Clinical Epidemiology Center, and the University Outpatient Clinic, University of Lausanne, Lausanne; Division of General Internal Medicine, Department of Internal Medicine, University of Geneva, Geneva, Switzerland; Division of General Internal Medicine, Department of Medicine; Department of Biostatistics, Graduate School of Public Health; Department of Emergency Medicine, University of Pittsburgh; VA Center for Health Equity Research and Promotion, and VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; and Department of Emergency Medicine, University of Angers, Angers, France

Correspondence and requests for reprints should be addressed to Drahomir Aujesky, M.D., M.Sc., Service de Médecine Interne, BH10-622, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland. E-mail: drahomir.aujesky{at}chuv.ch

Rationale: An objective and simple prognostic model for patients with pulmonary embolism could be helpful in guiding initial intensity of treatment.

Objectives: To develop a clinical prediction rule that accurately classifies patients with pulmonary embolism into categories of increasing risk of mortality and other adverse medical outcomes.

Methods: We randomly allocated 15,531 inpatient discharges with pulmonary embolism from 186 Pennsylvania hospitals to derivation (67%) and internal validation (33%) samples. We derived our prediction rule using logistic regression with 30-day mortality as the primary outcome, and patient demographic and clinical data routinely available at presentation as potential predictor variables. We externally validated the rule in 221 inpatients with pulmonary embolism from Switzerland and France.

Measurements: We compared mortality and nonfatal adverse medical outcomes across the derivation and two validation samples.

Main Results: The prediction rule is based on 11 simple patient characteristics that were independently associated with mortality and stratifies patients with pulmonary embolism into five severity classes, with 30-day mortality rates of 0–1.6% in class I, 1.7–3.5% in class II, 3.2–7.1% in class III, 4.0–11.4% in class IV, and 10.0–24.5% in class V across the derivation and validation samples. Inpatient death and nonfatal complications were 1.1% among patients in class I and 1.9% among patients in class II.

Conclusions: Our rule accurately classifies patients with pulmonary embolism into classes of increasing risk of mortality and other adverse medical outcomes. Further validation of the rule is important before its implementation as a decision aid to guide the initial management of patients with pulmonary embolism.

Key Words: mortality • prognosis • pulmonary embolism

This article has been cited by other articles:

				O. Sanchez, B. Planquette, and G. Meyer Update on acute pulmonary embolism Eur. Respir. Rev., September 1, 2009; 18(113): 137 - 147. [Full Text] [PDF]

				D. Aujesky, D. Jimenez, M. K. Mor, M. Geng, M. J. Fine, and S. A. Ibrahim Weekend Versus Weekday Admission and Mortality After Acute Pulmonary Embolism Circulation, February 24, 2009; 119(7): 962 - 968. [Abstract] [Full Text] [PDF]

				D. Aujesky, M. K. Mor, M. Geng, R. A. Stone, M. J. Fine, and S. A. Ibrahim Predictors of Early Hospital Readmission After Acute Pulmonary Embolism Arch Intern Med, February 9, 2009; 169(3): 287 - 293. [Abstract] [Full Text] [PDF]

				S. A. Ibrahim, R. A. Stone, D. S. Obrosky, M. Geng, M. J. Fine, and D. Aujesky Thrombolytic Therapy and Mortality in Patients With Acute Pulmonary Embolism Arch Intern Med, November 10, 2008; 168(20): 2183 - 2190. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, A. Torbicki, A. Perrier, S. Konstantinides, G. Agnelli, N. Galie, P. Pruszczyk, F. Bengel, A. J.B. Brady, D. Ferreira, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Eur. Heart J., September 2, 2008; 29(18): 2276 - 2315. [Full Text] [PDF]

				C. Kearon, S. R. Kahn, G. Agnelli, S. Goldhaber, G. E. Raskob, and A. J. Comerota Antithrombotic Therapy for Venous Thromboembolic Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 454S - 545S. [Abstract] [Full Text] [PDF]

				D. Aujesky, R. A. Stone, S. Kim, E. J. Crick, and M. J. Fine Length of Hospital Stay and Postdischarge Mortality in Patients With Pulmonary Embolism: A Statewide Perspective Arch Intern Med, April 14, 2008; 168(7): 706 - 712. [Abstract] [Full Text] [PDF]

				D. Jimenez, G. Diaz, J. Molina, D. Marti, J. Del Rey, S. Garcia-Rull, C. Escobar, R. Vidal, A. Sueiro, and R. D. Yusen Troponin I and risk stratification of patients with acute nonmassive pulmonary embolism Eur. Respir. J., April 1, 2008; 31(4): 847 - 853. [Abstract] [Full Text] [PDF]

				R. Otero, D. Jimenez, and on behalf of the Cooperative Study for the Ambulat Pulmonary embolism at home Eur. Respir. J., March 1, 2008; 31(3): 686 - 687. [Full Text] [PDF]

				D. Aujesky MD MSc, M. K. Mor PhD, M. Geng MS, M. J. Fine MD MSc, B. Renaud MD, and S. A. Ibrahim MD MPH Hospital volume and patient outcomes in pulmonary embolism Can. Med. Assoc. J., January 1, 2008; 178(1): 27 - 33. [Abstract] [Full Text] [PDF]

				R. Otero, J. Trujillo-Santos, A. Cayuela, C. Rodriguez, M. Barron, J. J. Martin, M. Monreal, and and the Registro Informatizado de la Enfermedad Tr Haemodynamically unstable pulmonary embolism in the RIETE Registry: systolic blood pressure or shock index? Eur. Respir. J., December 1, 2007; 30(6): 1111 - 1116. [Abstract] [Full Text] [PDF]

				C. W. H. Davies, J. Wimperis, E. S. Green, K. Pendry, J. Killen, I. Mehdi, C. Tiplady, P. Kesteven, P. Rose, and W. Oldfield Early discharge of patients with pulmonary embolism: a two-phase observational study Eur. Respir. J., October 1, 2007; 30(4): 708 - 714. [Abstract] [Full Text] [PDF]

				L. K. Moores There's No Place Like Home Chest, July 1, 2007; 132(1): 7 - 8. [Full Text] [PDF]

				D. Jimenez, R. D. Yusen, R. Otero, F. Uresandi, D. Nauffal, E. Laserna, F. Conget, M. Oribe, M. A. Cabezudo, and G. Diaz Prognostic Models for Selecting Patients With Acute Pulmonary Embolism for Initial Outpatient Therapy Chest, July 1, 2007; 132(1): 24 - 30. [Abstract] [Full Text] [PDF]

				F. Verschuren, N. Delvau, F. Thys, J. A. Kline, M. S. Runyon, W. B. Webb, A. A. Jones, and A. M. Mitchell Simplify d-Dimer Assay for Pulmonary Embolism Chest, February 1, 2007; 131(2): 633 - 634. [Full Text] [PDF]

				D. J. Perlroth, G. D. Sanders, and M. K. Gould Effectiveness and Cost-effectiveness of Thrombolysis in Submassive Pulmonary Embolism Arch Intern Med, January 8, 2007; 167(1): 74 - 80. [Abstract] [Full Text] [PDF]

				J. L. Lobo, V. Zorrilla, F. Aizpuru, F. Uresandi, F. Garcia-Bragado, F. Conget, and M. Monreal Clinical Syndromes and Clinical Outcome in Patients With Pulmonary Embolism: Findings From the RIETE Registry Chest, December 1, 2006; 130(6): 1817 - 1822. [Abstract] [Full Text] [PDF]

				S. A. Ibrahim, R. A. Stone, D. S. Obrosky, J. Sartorius, M. J. Fine, and D. Aujesky Racial Differences in 30-Day Mortality for Pulmonary Embolism Am J Public Health, December 1, 2006; 96(12): 2161 - 2164. [Abstract] [Full Text] [PDF]

				D. Aujesky Risk assessment in acute pulmonary embolism: reply Eur. Heart J., June 1, 2006; 27(11): 1384 - 1385. [Full Text] [PDF]

				M. M. Hoeper and L. J. Rubin Update in pulmonary hypertension 2005. Am. J. Respir. Crit. Care Med., March 1, 2006; 173(5): 499 - 505. [Full Text] [PDF]

				D. Aujesky, P.-M. Roy, C. P. Le Manach, F. Verschuren, G. Meyer, D. S. Obrosky, R. A. Stone, J. Cornuz, and M. J. Fine Validation of a model to predict adverse outcomes in patients with pulmonary embolism Eur. Heart J., February 2, 2006; 27(4): 476 - 481. [Abstract] [Full Text] [PDF]