Outpatient PE - sPESI or Hestia?

Written by Thomas Davis

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Simplified PESI (sPESI) and Hestia scores identified similar numbers of patients with pulmonary embolism as low risk. Both groups had similar 30-day all-cause mortality. However, interobserver reliability was better with sPESI.

Why does this matter?
ACEP and CHEST guidelines are encouraging us to send more patients home from the ED rather than admit. Until now, there has never been a prospective head-to-head comparison of the leading risk stratification scores— sPESI and Hestia.

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This was a single-center, prospective cohort study evaluating 488 patients diagnosed with symptomatic PE in the emergency department. The primary outcome of the study was 30-day all-cause mortality. sPESI and Hestia criteria classified similar proportions of patients as low risk (28% and 27%, respectively). Among those classified as low risk, there was a similar rate of all-cause mortality with no statistical difference: sPESI 0.7% (1/135) vs Hestia 2.3% (3/132). Two of the Hestia group deaths had cancer, which by definition would have been high risk using sPESI. Interobserver reliability of sPESI was very good, with disagreement in only 1.2% of patients. Hestia was still good but had disagreements in 7.6% due to having more subjective criteria. This study was limited by having low event rates in a single center and did not assess for non-fatal adverse events, such as recurrent VTE or bleeding.

Source
Accuracy and interobserver reliability of the simplified pulmonary embolism severity index versus the hestia criteria for patients with pulmonary embolism. Acad Emerg Med. 2018 Aug 29. doi: 10.1111/acem.13561. [Epub ahead of print]

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Reviewed by Clay Smith

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