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

Wendy Zondag; Paul L. den Exter; Monique J. T. Crobach; Anneke Dolsma; Marjolein L. Donker; Michiel Eijsvogel; Laura M. Faber; Herman M. A. Hofstee; Karin A. H. Kaasjager; Marieke J. H. A. Kruip; Geert Labots; Christian F. Melissant; Michelle S. G. Sikkens; Menno V. Huisman

doi:10.1160/TH12-07-0466

Thrombosis and Haemostasis, Table of Contents

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

Authors

Wendy Zondag^*

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center (LUMC), Leiden, The Netherlands
Paul L. den Exter^*

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center (LUMC), Leiden, The Netherlands
Monique J. T. Crobach

²Department of General Internal Medicine, Bronovo Hospital, The Hague, The Netherlands
Anneke Dolsma

³Department of Pulmonology, Diaconessenhuis, Leiden, The Netherlands
Marjolein L. Donker

⁴Department of General Internal Medicine, Rijnland Hospital, Leiderdorp, The Netherlands
Michiel Eijsvogel

⁵Department of Pulmonology, Medical Spectrum Twente, Enschede, The Netherlands
Laura M. Faber

⁶Department of General Internal Medicine, Rode Kruis Hospital, Beverwijk, The Netherlands
Herman M. A. Hofstee

⁷Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
Karin A. H. Kaasjager

⁸Department of General Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
Marieke J. H. A. Kruip

⁹Department of Hematology, Erasmus Medical Centre, Rotterdam, The Netherlands
Geert Labots

¹⁰Department of General Internal Medicine, Haga Hospital, The Hague, The Netherlands
Christian F. Melissant

¹¹Department of Pulmonology, Spaarne Hospital, Hoofddorp, The Netherlands
Michelle S. G. Sikkens

¹²Department of Internal Medicine, Haaglanden Medical Centre, The Hague, The Netherlands
Menno V. Huisman

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center (LUMC), Leiden, The Netherlands

Abstract

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.

Keywords

Pulmonary embolism - thrombosis - outpatient treatment - mortality

Full Text

References

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