Is there a role for risk stratification for ambulatory management of Pulmonary Embolism?

Abstract

Background: The European Society of Cardiology recommends the use of risk stratification in assessing Pulmonary embolism (PE) such as the PE severity index (PESI) or simplified PESI (sPESI) scores. This may identify a subset for patients for ambulatory management and predict mortality. Aims: 1) evaluate the role for risk stratification in PE 2) define the appropriate statistical model for risk stratification 3) analyse the impact of risk stratification in a hospital. Methods: A retrospective cohort study on patients with confirmed radiological diagnosis of PE in 2013-14. Clinical, radiological, treatment and follow-up data were recorded. Outcome measures included: 30-day and 1-year mortality. Patients were categorised into low and high-risk groups, with categorical variables compared using Fisher9s Exact testing, and risk modelling performed using receiving operator curve analysis. Kaplan-Meier survivals were produced. Results: 186 patients had confirmed PE. In the low sPESI group, 30-day mortality was 0% compared to 7.9% in the high sPESI group (p=0.03). Similarly, 30-day mortality was 0% in low PESI groups compared to 8.7% in the high PESI groups (p=0.007). Patients with low risk PESI had 96% 1-year survival rates compared to 30.4% for high risk PESI (hazard ratio 0.12, p Conclusion: Low PESI and sPESI predict 30-day and 1-year mortality. PESI appears to be superior to sPESI for risk stratification. Applying PESI scoring appears to be safe and may reduce admissions for low risk patients.