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New PE-SCORE – Predicting Near-Term PE Outcomes

January 20, 2022

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Written by Clay Smith

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The PE-SCORE has been derived and validated to determine which patients with PE are at risk of clinical deterioration or death. Patients with a score of 0 had an 8% chance of deterioration but no death; scores ≥6 all had deterioration or death.

Why does this matter?
When a patient has PE, it’s important to determine their risk of short-term bad outcomes or death so we can admit them vs discharging them and to ensure higher risk people go to the ICU. We currently use PESI, sPESI, or Hestia criteria to do this. But these scores don’t take the status of the RV into consideration. How does the PE-SCORE, which looks at the RV, perform?

Turns out, the RV matters in predicting PE outcomes
They used a prospectively collected database with 935 patients to consider 138 potential variables and whittled it down to 9 to make the PE-SCORE. The primary outcome was a, “composite of death (all cause and PE-related) and clinical deterioration* within five days of index PE confirmation.”

They derived the variables of the PE-SCORE** using one prospective database from the 6 US academic hospitals. Then they validated them on another prospectively collected database, 801 patients, with enrollment from the same 6 sites. In the validation set, 8% of patients with a score of 0 had the composite primary outcome (though none died). Using a score of zero to determine a low-risk group (such as those who might be safe for outpatient treatment), the negative predictive value was 97.9%. At a score of ≥6, all patients had the primary outcome. Using a cutpoint of ≥5 to define high-risk patients, the positive predictive value was 90.6%. Now the PE-SCORE needs additional external validation and implementation studies.

Source
Development and validation of a prognostic tool: Pulmonary embolism short-term clinical outcomes risk estimation (PE-SCORE). PLoS One. 2021 Nov 18;16(11):e0260036. doi: 10.1371/journal.pone.0260036.

*Deterioration was defined as: “respiratory failure, cardiac arrest, new dysrhythmia, sustained hypotension requiring intravenous volume expansion or adrenergic medication, and rescue reperfusion intervention.”

**Criteria in the PE-SCORE were: 2 points – creatinine > 2.0 mg/dL; all others 1 point: dysrhythmia, suspected/confirmed systemic infection, SBP < 100 mmHg, abnormal heart rate (<50 or >100 beats/min), syncope, medical or social reason for hospitalization, POCUS with abnormal RV (done by ED docs using RV:LV basal diameter ≥1.0 and more criteria), CT RV:LV ratio ≥1.0.

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