Thromb Haemost 2013; 109(01): 47-52
DOI: 10.1160/TH12-07-0466
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Comparison of two methods for selection of out of hospital treatment in patients with acute pulmonary embolism

Wendy Zondag*
1  Department of Thrombosis and Hemostasis, Leiden University Medical Center (LUMC), Leiden, The Netherlands
,
Paul L. den Exter*
1  Department of Thrombosis and Hemostasis, Leiden University Medical Center (LUMC), Leiden, The Netherlands
,
Monique J. T. Crobach
2  Department of General Internal Medicine, Bronovo Hospital, The Hague, The Netherlands
,
Anneke Dolsma
3  Department of Pulmonology, Diaconessenhuis, Leiden, The Netherlands
,
Marjolein L. Donker
4  Department of General Internal Medicine, Rijnland Hospital, Leiderdorp, The Netherlands
,
Michiel Eijsvogel
5  Department of Pulmonology, Medical Spectrum Twente, Enschede, The Netherlands
,
Laura M. Faber
6  Department of General Internal Medicine, Rode Kruis Hospital, Beverwijk, The Netherlands
,
Herman M. A. Hofstee
7  Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
,
Karin A. H. Kaasjager
8  Department of General Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
,
Marieke J. H. A. Kruip
9  Department of Hematology, Erasmus Medical Centre, Rotterdam, The Netherlands
,
Geert Labots
10  Department of General Internal Medicine, Haga Hospital, The Hague, The Netherlands
,
Christian F. Melissant
11  Department of Pulmonology, Spaarne Hospital, Hoofddorp, The Netherlands
,
Michelle S. G. Sikkens
12  Department of Internal Medicine, Haaglanden Medical Centre, The Hague, The Netherlands
,
Menno V. Huisman
1  Department of Thrombosis and Hemostasis, Leiden University Medical Center (LUMC), Leiden, The Netherlands
› Author Affiliations
Financial support: This study was funded by an unrestricted research grant from Glaxo Smith Klein, The Netherlands BV.
Further Information

Publication History

Received: 06 July 2012

Accepted after major revision: 08 October 2012

Publication Date:
27 November 2017 (online)

Summary

The aim of this study is to compare the performance of two clinical decision rules to select patients with acute pulmonary embolism (PE) for outpatient treatment: the Hestia criteria and the simplified Pulmonary Embolism Severity Index (sPESI). From 2008 to 2010, 468 patients with PE were triaged with the Hestia criteria for outpatient treatment: 247 PE patients were treated at home and 221 were treated as inpatients. The outcome of interest was all-cause 30-day mortality. In a post-hoc fashion, the sPESI items were scored and patients were classified according to the sPESI in low and high risk groups. Of the 247 patients treated at home, 189 (77%) patients were classified as low risk according to the sPESI and 58 patients (23%) as high risk. In total, 11 patients died during the first month; two patients treated at home and nine patients treated in-hospital. None of the patients treated at home died of fatal PE. Both the Hestia criteria and sPESI selected >50% of patients as low risk, with good sensitivity and negative predictive values for 30-day mortality: 82% and 99% for the Hestia criteria and 91% and 100% for the sPESI, respectively. The Hestia criteria and the sPESI classified different patients eligible for out-patient treatment, with similar low risks for 30-day mortality. This study suggests that the Hestia criteria may identify a proportion of high risk sPESI patiennts who can be safely treated at home, this however requires further validation.

* Both authors contributed equally to the manuscript.