Patel Kajal, Klim Sharon, Ritchie Peter, Johns Ieuan, Kelly Anne-Maree
Department of Emergency Medicine, Western Health, Footscray, VIC, Australia.
Joseph Epstein Centre for Emergency Medicine Research, Western Health, St Albans, VIC, Australia.
Clin Exp Emerg Med. 2020 Jun;7(2):107-113. doi: 10.15441/ceem.19.051. Epub 2020 Jun 28.
Recently, a novel score for risk stratification of patients with pulmonary embolism (PE)-the HOPPE score-was derived. We aimed to externally validate the HOPPE score in emergency department-diagnosed PE, using SpO2 as a surrogate for PaO2-the modified HOPPE score.
Retrospective observational study of adult patients with an emergency department diagnosis of PE was performed. Data collected included demographics, co-morbidities, clinical features, electrocardiogram and test results, in-hospital mortality and non-fatal major adverse clinical events (MACE; survived cardiac arrest, cardiogenic shock or thrombolysis administration). The primary outcome of interest was clinical performance of the modified HOPPE score for inhospital mortality and the composite outcome of in-hospital death and MACE. A secondary outcome was comparison of predictive performance between the modified HOPPE score and the simplified Pulmonary Embolism Severity Index score.
Two hundred and six patients were studied (median age 61, 55% female). There were no deaths or MACE in patients with a low risk modified HOPPE score of 0 to 6 (0%; 95% confidence interval, 0% to 1.8%). Negative predictive value of a low risk score was 100% (95% confidence interval, 92.2% to 100%) for in-hospital mortality and for the composite of in-hospital mortality or MACE. The modified HOPPE score had similar predictive performance to the simplified Pulmonary Embolism Severity Index score with an area under the curve of 0.88 vs. 0.80 for the composite outcome of in-hospital mortality or MACE (P=0.052). Twenty-eight percent of the patients were classified as low risk and potentially suitable for management as outpatients.
The modified HOPPE score showed good clinical performance. Prospective validation is warranted.
最近，一种用于肺栓塞（PE）患者风险分层的新评分——HOPPE评分被推导出来。我们旨在使用SpO2替代PaO2（改良HOPPE评分），在急诊科诊断的PE患者中对HOPPE评分进行外部验证。
对急诊科诊断为PE的成年患者进行回顾性观察研究。收集的数据包括人口统计学、合并症、临床特征、心电图和检查结果、住院死亡率和非致命性主要不良临床事件（MACE；心脏骤停存活、心源性休克或溶栓治疗）。感兴趣的主要结局是改良HOPPE评分对住院死亡率的临床性能以及住院死亡和MACE的复合结局。次要结局是比较改良HOPPE评分与简化肺栓塞严重程度指数评分之间的预测性能。
共研究了206例患者（中位年龄61岁，55%为女性）。改良HOPPE低风险评分0至6分的患者中无死亡或MACE发生（0%；95%置信区间，0%至1.8%）。低风险评分对住院死亡率以及住院死亡率或MACE复合结局的阴性预测值为100%（95%置信区间，92.2%至100%）。改良HOPPE评分与简化肺栓塞严重程度指数评分具有相似的预测性能，住院死亡率或MACE复合结局的曲线下面积分别为0.88和0.80（P=0.052）。28%的患者被分类为低风险，可能适合作为门诊患者管理。
改良HOPPE评分显示出良好的临床性能。有必要进行前瞻性验证。
