Prognostic models for selecting patients with acute pulmonary embolism for initial outpatient therapy

Abstract

This paper reviews recently described prognostic prediction rules (the Geneva score, the Pulmonary Embolism Severity Index, the Spanish score, the Davies criteria, and the HOme Management Exclusion criteria) for patients with acute symptomatic pulmonary embolism, and discusses their usefulness in decision-making regarding the appropriate initial therapy and treatment setting. A recently published external validation study directly compared the Pulmonary Embolism Severity Index and the Geneva score in 599 consecutive patients with acute symptomatic pulmonary embolism diagnosed in the emergency department. Compared with the Geneva score low-risk patients, the Pulmonary Embolism Severity Index low-risk patients had a significantly lower mortality. Using pooled results of the validation studies, the Pulmonary Embolism Severity Index classified approximately half of patients diagnosed with acute symptomatic pulmonary embolism in emergency departments at very low risk for mortality and other adverse events. Alternatively, the conservative HOme Management Exclusion criteria found that only 9% of patients diagnosed in the emergency department met criteria to undergo outpatient treatment of their acute pulmonary embolism. Predictive models identify patients with acute symptomatic pulmonary embolism who are at low risk of fatal and nonfatal adverse outcomes. Clinicians should incorporate predictive models into treatment algorithms for patients with acute symptomatic pulmonary embolism diagnosed in the emergency department.