Derivation and Validation of a Prognostic Model for Pulmonary Embolism

• Published in: American journal of respiratory and critical care medicine 2005-10, Vol.172 (8), p.1041-1046
• Main Authors: Aujesky, Drahomir, Obrosky, D. Scott, Stone, Roslyn A, Auble, Thomas E, Perrier, Arnaud, Cornuz, Jacques, Roy, Pierre-Marie, Fine, Michael J
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cause of Death; Comorbidity; Decision Support Techniques; Discriminant Analysis; Female; France - epidemiology; Hospitals; Hospitals, University; Humans; Intensive care medicine; J. Pulmonary Vascular Disease; Laboratories; Logistic Models; Male; Medical sciences; Metabolic diseases; Mortality; Obesity; Patients; Pennsylvania - epidemiology; Pneumology; Predictive Value of Tests; Prognosis; Pulmonary Embolism - classification; Pulmonary Embolism - complications; Pulmonary Embolism - diagnosis; Pulmonary Embolism - mortality; Pulmonary Embolism - therapy; Pulmonary embolisms; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Regression analysis; Risk Assessment - organization & administration; Risk Factors; ROC Curve; Severity of Illness Index; Switzerland - epidemiology; Tomography
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.200506-862OC

An objective and simple prognostic model for patients with pulmonary embolism could be helpful in guiding initial intensity of treatment. 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. 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. We compared mortality and nonfatal adverse medical outcomes across the derivation and two validation samples. 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