Gossage identified risk factors for mortality in a patient with recurrent pulmonary embolism. This can help identify a patient who requires aggressive anticoagulation and possibly placement of a filter in the inferior vena cava. The author is from the Medical College of Georgia.
Patient selection: recent significant pulmonary embolus.
Risk factors:
(1) age
(2) PaO2-to-FIO2 ratio
(3) heart rate
(4) systolic pulmonary artery blood pressure
(5) mean pulmonary artery blood pressure
(6) underlying cardiopulmonary disease
|
Parameter |
Finding |
Points |
|
age |
<= 65 years of age |
0 |
|
|
> 65 years |
1 |
|
PaO2 to FIO2 ratio |
>= 250 |
0 |
|
|
< 250 |
1 |
|
heart rate |
<= 120 beats per minute |
0 |
|
|
> 120 |
1 |
|
systolic pulmonary artery pressure |
<= 50 mm Hg |
0 |
|
|
> 50 mm Hg |
1 |
|
mean pulmonary artery pressure |
<= 30 |
0 |
|
|
> 30 |
1 |
|
underlying cardiopulmonary disease |
none |
0 |
|
|
not significant |
0 |
|
|
significant |
1 |
where:
• mean arterial pressure = ((systolic blood pressure) + (2 * (diastolic blood pressure))) / 3
number of risk factors =
= SUM(points for the risk factors)
The patient is high risk for mortality if a recurrent pulmonary embolus occurs if:
(1) number of risk factors >= 1
(2) right ventricular dysfunction demonstrated on echocardiography.
Even a small embolus can result in hemodynamic instability and death.
Specialty: Pulmonology
ICD-10: ,
