Development and Validation of a Simple Prediction Rule to Exclude Pulmonary Embolism

2006 ◽  
Vol 13 (5Supplement 1) ◽  
pp. S158-S158
Author(s):  
M. A. Rodger
Keyword(s):  
Pulmonary Embolism ◽  
Prediction Rule ◽  
Development And Validation

Prognostic value of the Geneva prediction rule in patients in whom pulmonary embolism is ruled out

2010 ◽  
Vol 269 (4) ◽  
pp. 433-440 ◽  
Author(s):  
L. Bertoletti ◽  
G. Le Gal ◽  
D. Aujesky ◽  
P. -M. Roy ◽  
O. Sanchez ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Prognostic Value ◽  
Prediction Rule

scholarly journals Influence of specific alternative diagnoses on the probability of pulmonary embolism

2006 ◽  
Vol 95 (06) ◽  
pp. 958-962 ◽  
Author(s):  
Ariane Testuz ◽  
Grégoire Le Gal ◽  
Marc Righini ◽  
Henri Bounameaux ◽  
Arnaud Perrier
Keyword(s):  
Pulmonary Embolism ◽  
Reference Group ◽  
Diagnostic Testing ◽  
Diagnostic Category ◽  
Prediction Rule ◽  
Important Variable ◽  
Alternative Diagnosis ◽  
Clinical Probability ◽  
Medical Centers ◽  
Specific Alternative

SummaryThe presence and likelihood of an alternative diagnosis to pulmonary embolism is an important variable of the Wells’ prediction rule for establishing clinical probability. We assessed whether evoking specific alternative diagnoses would reduce the probability of pulmonary embolism enough to forego further testing. We retrospectively studieda cohort of 965 consecutive patients admitted for suspicion of pulmonary embolism at three medical centers in Europe in whom the presence of an alternative diagnosis at least as likely as pulmonary embolism was recorded before diagnostic testing. We divided the patients into 15 categories of alternative diagnoses evoked. We then assessed the prevalence of pulmonary embolism in each diagnostic category and compared it to the prevalence of pulmonary embolism ina reference group (patients with no alternative diagnosis or a diagnosis less likely than pulmonary embolism). The prevalence of pulmonary embolism in the reference group was 48%. The presence of an alternative diagnosis as or more likely strongly reduced the probability of pulmonary embolism (OR 0.15, 95% CI: 0.1–0.2, p<0.01). In almost every diagnostic category, the prevalence of pulmonary embolism was much lower than in the reference group whith an odds ratio below or near 0. 2. Bronchopneumonia (OR 0.4, 95% CI 0.2 to 0.7) and cancer (OR 0.6, 95% CI 0. 3 to 1.5) reduced the likelihood of pulmonary embolism toa lower extent. Evoking an alternative diagnosis at least as likely as pulmonary embolism reduces the probability of the disease, but this effect is never large enough to allow ruling it out without further testing, especially when bronchopneumonia or cancer are the alternative diagnoses considered.

Performance of a diagnostic algorithm based on a prediction rule, D-dimer and CT-scan for pulmonary embolism in patients with previous venous thromboembolism

2015 ◽  
Vol 113 (02) ◽  
pp. 406-413 ◽  
Author(s):  
Paul L. den Exter ◽  
Inge C. M. Mos ◽  
Menno V. Huisman ◽  
Frederikus A. Klok ◽  
Maria José Fabiá Valls ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Random Effect ◽  
Prediction Rule ◽  
Diagnostic Algorithm ◽  
Clinical Prediction Rule ◽  
Incidence Rates ◽  
Specific Patient ◽  
History Of ◽  
D Dimer

SummaryDiagnostic management of suspected pulmonary embolism (PE) in patients with a history of venous thromboembolism (VTE) is complicateddue to persistent abnormal D-dimer levels, residual embolic obstruction and higher clinical prediction rule (CPR) scores. We aimed to evaluate the safety and efficiency of the standard diagnostic algorithm consisting of a CPR, D-dimer test and computed tomography pulmonary angiography (CTPA) in this specific patient category. We performed a systematic literature search for prospective studies evaluating a diagnostic algorithm in consecutive patients with clinically suspected PE and a history of VTE. The VTE incidence rates during three-month follow-up and the number of indicated CTPAs were pooled using random effect models. Four studies concerning 1,286 patients were included with a pooled baseline PE prevalence of 36 % (95 % confidence interval [CI] 30–42). In only 217 patients (15 %; 95 %CI 11–20) PE could be excluded without CTPA. The three-month VTE incidence rate was 0.8 % (95 %CI 0.06–2.4) in patients managed without CTPA, 1.6 % (95 %CI 0.3–4.0) in patients in whom PE was excluded by CTPA and 1.4 % (95 %CI 0.6–2.7) overall. In the pooled studies, PE was safely excluded in patients with a history of VTE based on a CPR followed by a D-dimer test and/or CTPA, although the efficiency of the algorithm is relatively low compared to patients without a history of VTE.

Accuracy of the Wells Clinical Prediction Rule for Pulmonary Embolism in Older Ambulatory Adults

2014 ◽  
Vol 62 (11) ◽  
pp. 2136-2141 ◽  
Author(s):  
Henrike J. Schouten ◽  
Geert-Jan Geersing ◽  
Ruud Oudega ◽  
Johannes J.M. van Delden ◽  
Karel G.M. Moons ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Clinical Prediction

Validation of the Inhospital Mortality for Pulmonary Embolism Using Claims Data (IMPACT) Prediction Rule within an All-Payer Inpatient Administrative Claims Database

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 747-747
Author(s):  
Craig I Coleman ◽  
Christine G Kohn ◽  
Concetta Crivera ◽  
Jeff Schein ◽  
W Frank Peacock
Keyword(s):  
Pulmonary Embolism ◽  
Hospital Mortality ◽  
Research Funding ◽  
Prediction Rule ◽  
Low Risk ◽  
Administrative Claims ◽  
Claims Database ◽  
Impact Prediction ◽  
Risk Patients ◽  
Equity Ownership

Background: Current guidelines suggest that low risk pulmonary embolism (PE) patients may be managed as outpatients or with an abbreviated hospital stay. There is need for a claims-based prediction rule that payers and hospitals can use to efficiently risk stratify PE patients. The authors recently derived a rule found to have high sensitivity and moderate specificity for predicting in-hospital mortality. Objective: To validate the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) prediction rule originally developed in a commercial claims database in an all-payer administrative database restricted to inpatient claims. Methods: This study utilized data from the 2012 Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS). Adult PE admissions were identified by the presence of an appropriate International Classification of Diseases, ninth edition, Clinical Modification (ICD-9-CM) code either in the primary position or secondary position when accompanied by a primary code for a PE complication. The IMPACT rule, consists of age + 11 weighted comorbidities calculated based upon the maximum of 25 ICD-9-CM diagnosis codes and 25 procedural codes reported for each discharge in the NIS (myocardial infarction, chronic lung disease, stroke, prior major bleeding, atrial fibrillation, cognitive impairment, heart failure, renal failure, liver disease, coagulopathy, cancer), and was used to estimate patients' risk of in-hospital mortality. Low risk was defined as in-hospital mortality ≤1.5%. We present the validity of the rule by calculating prognostic test characteristics and 95% confidence intervals (CIs). In order to estimate the potential cost savings from an early discharge, we calculated the difference in total hospital costs between low-risk patients having and not having an abbreviated hospital stay (defined as ≤1, ≤2 or ≤3 days). Results: A total of 34,108 admissions for PE were included (46.7% male, mean ± standard deviation age of 61.9±17.2); and we observed a 3.4% in-hospital PE case-fatality rate. The IMPACT prediction rule classified 11,025 (32.3%) patient admissions as low-risk; and had a sensitivity of 92.4% (95%CI=90.7-93.8), specificity of 33.2% (95%CI=32.7-33.7), negative and positive predictive values of 99.2% (95%CI=99.0-99.4) and 4.6% (95%CI=4.4-4.9) and a C-statistic of 0.74 (95%CI=0.73-0.76) for in-hospital mortality. Low-risk patients had significantly lower in-hospital mortality (0.8% vs. 4.6%, odds reduction of 83%; 95%CI=79-87), shorter LOSs (-1.2 days, p<0.001) and lower total treatment costs (-$3,074, p<0.001) than patients classified as higher-risk. Of low-risk patients, 13.1%, 31.1% and 47.7% were discharged within 1, 2 and 3 days of admission. Low-risk patients discharged within 1 day accrued $5,465 (95%CI=$5,018-$5,911) less in treatment costs than those staying longer. Discharge within 2 or 3 days in low-risk patients was also associated with a reduced cost of hospital treatment [$5,820 (95%CI=$5,506-$6,133) and $6,314 (95%CI=$6,031-$6,597), respectively] when compared to those staying longer. Conclusion: The prior claims-based in-hospital mortality prediction rule was valid when used in this all-payer, inpatient only administrative claims database. The rule classified patients' mortality risk with high sensitivity and had a high negative predictive value; and consequently, may be valuable to those wishing to benchmark rates of PE treated at home or following an abbreviated hospital admission. Disclosures Coleman: Janssen Scientific Affairs, LLC: Consultancy, Research Funding. Crivera:Janssen Scientific Affairs, LLC: Employment, Equity Ownership. Schein:Janssen Scientific Affairs, LLC: Employment. Peacock:Singulex: Consultancy; Prevencio: Consultancy; The Medicines Company: Consultancy, Research Funding; Roche: Consultancy, Research Funding; Portola: Consultancy, Research Funding; Janssen Pharmaceuticals: Consultancy, Research Funding; Cardiorentis: Research Funding; Banyan: Research Funding; Alere: Research Funding; Abbott: Research Funding; Comprehensive Research Associates, LLC: Equity Ownership; Emergencies in Medicine, LLC: Equity Ownership.

Multivariate Analysis-Based Prediction Rule for Pulmonary Embolism

2000 ◽  
Vol 97 (5) ◽  
pp. 267-273 ◽  
Author(s):  
Claudia Stöllberger ◽  
Josef Finsterer ◽  
Wolfgang Lutz ◽  
Christiane Stöberl ◽  
Alois Kroiss ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Multivariate Analysis ◽  
Prediction Rule
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