Division of General Internal Medicine, University of Lausanne, Lausanne, Switzerland.
J Thromb Haemost. 2010 Jun;8(6):1242-7. doi: 10.1111/j.1538-7836.2010.03836.x. Epub 2010 Mar 3.
We previously derived a clinical prognostic algorithm to identify patients with pulmonary embolism (PE) who are at low risk of short-term mortality and who could be safely discharged early or treated entirely in an outpatient setting.
To externally validate the clinical prognostic algorithm in an independent patient sample.
We validated the algorithm in 983 consecutive patients prospectively diagnosed with PE at an emergency department of a university hospital. Patients with none of the algorithm's 10 prognostic variables (age > or = 70 years, cancer, heart failure, chronic lung disease, chronic renal disease, cerebrovascular disease, pulse > or = 110 min(-1), systolic blood pressure < 100 mmHg, oxygen saturation < 90%, and altered mental status) at baseline were defined as being at low risk. We compared 30-day overall mortality among low-risk patients, on the basis of the algorithm, between the validation sample and the original derivation sample. We also assessed the rate of PE-related and bleeding-related mortality among low-risk patients.
Overall, the algorithm classified 16.3% of patients with PE as being at low risk. Mortality at 30 days was 1.9% among low-risk patients, and did not differ between the validation sample and the original derivation sample. Among low-risk patients, only 0.6% died from definite or possible PE, and 0% died from bleeding.
This study validates an easy-to-use, clinical prognostic algorithm for PE that accurately identifies patients with PE who are at low risk of short-term mortality. Patients who are at low risk according to our algorithm are potential candidates for less costly outpatient treatment.
我们之前开发了一种临床预后算法，用于识别患有肺栓塞（PE）的患者，这些患者短期死亡率较低，可以安全地提前出院或完全在门诊接受治疗。
在独立患者样本中对临床预后算法进行外部验证。
我们前瞻性地在一家大学医院的急诊科对 983 例连续确诊为 PE 的患者验证了该算法。基线时无算法 10 个预后变量（年龄≥70 岁、癌症、心力衰竭、慢性肺部疾病、慢性肾脏疾病、脑血管疾病、脉搏≥110 次/分、收缩压<100mmHg、氧饱和度<90%和意识状态改变）的患者被定义为低危。我们比较了验证样本和原始推导样本中根据算法定义的低危患者的 30 天总死亡率。我们还评估了低危患者中 PE 相关和出血相关死亡率。
总体而言，该算法将 16.3%的 PE 患者归类为低危。低危患者 30 天死亡率为 1.9%，在验证样本和原始推导样本之间无差异。在低危患者中，仅有 0.6%死于明确或可能的 PE，无患者死于出血。
本研究验证了一种简单易用的 PE 临床预后算法，该算法可准确识别短期死亡率较低的 PE 患者。根据我们的算法，低危患者是成本较低的门诊治疗的潜在候选者。
