Morillo et al developed a stepwise approach for risk stratification for a patient with a pulmonary embolism. This can help guide patient management. The authors are from Alcala de Henares University in Madrid and the Uniformed Services University in Bethesda.
Patient selection: pulmonary embolism
Parameters:
(1) clinical stability
(2) s-PESI
(3) Bova score
(4) Hestia criteria
A patient was clinically unstable if:
(1) systolic blood pressure < 90 mm Hg OR drops >= 40 mm, for > 15 minutes
(2) NOT due to sepsis, hypovolemia, new-onset cardiac arrhythmia or cardiogenic shock
Stability
s-PESI
Bova
Hestia
Group
stable
negative
NA
negative
1
stable
negative
NA
positive
2
stable
positive
<= 4
NA
3
stable
positive
>= 5
NA
4
unstable
NA
NA
NA
5
Group
Risk Group
Anticoagulation
1
low
outpatient
2
low
early discharge
3
low-to-intermediate
medical ward
4
intermediate-to-high
intermediate care unit
5
high
ICU, with recanalization
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