Abstract：
BACKGROUND AND OBJECTIVE:To determine the accuracy of clinical gestalt to identify patients with acute symptomatic pulmonary embolism (PE) at low-risk for short-term complications. PATIENTS AND METHODS:This study included a total of 154 consecutive patients diagnosed with acute symptomatic PE in a tertiary university hospital. We compared the prognostic accuracy of the Pulmonary Embolism Severity Index (PESI), the simplified PESI (sPESI), and clinical gestalt of 1) 2senior physicians (one with and one without experience in the management of patients with PE), 2) a fourth-year resident of Pneumology, 3) a third-year resident of Pneumology, and 4) a second-year resident of Pneumology. The primary outcome was all-cause mortality during the first month after the diagnosis of PE. RESULTS:Thirty-day all-cause mortality was 8.4% (13/154; 8.4%; 95% confidence interval [CI], 4.1-12.8%). The PESI and clinical gestalt classified more patients as low-risk, compared to the sPESI (36.4%, 31.3% y 28.6%, respectively). There were no deaths in the sPESI low-risk category (negative predictive value 100%). Prognostic accuracy increased with increasing experience (84.6 vs. 92.3%; P=.049). CONCLUSIONS:The sPESI showed the best accuracy at correctly identifying low-risk patients with acute symptomatic PE. Clinical gestalt is not inferior to standardized clinical prediction rules to prognosticate patients with acute PE.
journal_name
Med Clin (Barc)journal_title
Medicina clinicaauthors
Quezada CA,Zamarro C,Gómez V,Guerassimova I,Nieto R,Barbero E,Chiluiza D,Barrios D,Morillo R,Jiménez Ddoi
10.1016/j.medcli.2017.11.023subject
Has Abstractpub_date
2018-08-22 00:00:00pages
136-140issue
4eissn
0025-7753issn
1578-8989pii
S0025-7753(17)30904-1journal_volume
151pub_type
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