Sanchez et al developed a bedside score for predicting 30-day adverse events following a pulmonary embolism. This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple hospitals in France, Belgium and Switzerland.
Patient selection: pulmonary embolism (PE)
Outcome: 30-day occurrence of death, secondary cardiogenic shock or recurrent PE
Parameters:
(1) mental status (altered if there is disorientation, stupor or coma)
(2) cardiogenic shock on admission (one or more of systolic blood pressure < 90 mm Hg, need for pressor support, signs of systemic hypoperfusion)
(3) cancer
(4) serum BNP in ng/L (analytical method and reference ranges not stated)
(5) ratio of right ventricle (RV) to left ventricle (LV) based on end-diastolic diameters in the long axis parasternal view
|
Parameter
|
Finding
|
Points
|
|
mental status
|
normal
|
0
|
|
|
altered
|
10
|
|
cardiogenic shock
|
absent
|
0
|
|
|
present
|
6
|
|
cancer
|
absent
|
0
|
|
|
present
|
6
|
|
BNP
|
< 100 ng/L
|
0
|
|
|
100 to 249
|
1
|
|
|
250 to 499
|
2
|
|
|
500 to 999
|
4
|
|
|
>= 1,000 ng/L
|
8
|
|
RV to LV ratio
|
< 0.5
|
0
|
|
|
0.5 to 0.74
|
3
|
|
|
0.75 to 1.00
|
5
|
|
|
1.00 to 1.25
|
8
|
|
|
> 1.25
|
11
|
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 41
• The higher the score the greater the risk for complications in the 30-days after onset.
|
Total Score
|
Risk Class
|
30-Day Adverse Event
|
|
<= 6
|
I (low)
|
< 5%
|
|
7 to 17
|
II (intermediate)
|
5 to 30%
|
|
18 to 41
|
III (high)
|
> 30%
|
Performance:
• The area under the ROC curve is 0.84.
