Carmona-Bayonas et al developed a decision tree for evaluating a patient with cancer and a pulmonary embolism. This can help to identify a patient with a serious complication. The authors are from multiple institutions in Spain participating in the Region of Murcia's Association of Thromboembolic Disease Research.
Patient selection: pulmonary embolism and cancer
Outcome: serious complications within 15 days (hypotension, acute respiratory failure, right-sided heart failure, acute kidney failure, major bleeding, death or any other form of serious clinical deterioration)
Risk factors:
(1) systolic blood pressure < 100 mm Hg
(2) arterial oxygen saturation < 90%
(3) respiratory rate >= 30 breaths per minute
(4) pulse >= 110 beats per minute
(5) sudden or progressive dyspnea
(6) coagulation disorder (clinically relevant hemorrhage, high risk of bleeding, or platelet count < 50,000 per µL)
Parameters:
(1) number of risk factors present
(2) ECOG performance status
(3) oxygen saturation in percent (SaO2)
(4) pulmonary embolism specific symptoms (chest pain, syncope, dyspnea)
(5) cancer status the time of PE (progressive or unknown versus complete response, partial response or stable disease)
(6) prior surgical resection of the primary tumor
For patients with 1 or more risk factors:
|
ECOG
|
SaO2
|
PE Symptoms
|
Complications
|
|
< 2
|
NA
|
no
|
6.9%
|
|
< 2
|
NA
|
yes
|
20%
|
|
>= 2
|
>= 90%
|
NA
|
32%
|
|
>= 2
|
< 90%
|
NA
|
55%
|
For patients with no risk factors"
|
Cancer Status
|
Surgery
|
Complications
|
|
not progressive
|
NA
|
1.4%
|
|
progressive
|
no
|
11%
|
|
progressive
|
yes
|
3.4%
|
Performance:
• The area under the ROC curve was 0.78.
