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Rules for predicting PE mortality show high sensitivity, low specificity
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Various prediction rules physicians used to determine early mortality in patients with acute pulmonary embolism had high sensitivity rates, for the most part, but relatively low specificity rates, according to study results.
“These tools have high sensitivity and accurately classify essentially all patients who ultimately die following [acute pulmonary embolism (aPE)] into the high-risk group,” Christine G. Kohn, PharmD, of the University of Saint Joseph School of Pharmacy in Hartford, Connecticut, and colleagues wrote. “However, none demonstrated specificity [greater than] 48%, meaning that many patients classified as high risk actually survived the respective study period.”
Kohn and colleagues conducted a systematic literature review of Medline and Embase from January 2000 to March 2014 to determine the accuracy of various prediction rules for identifying patients with aPE at low risk for mortality.
Among 40 included studies, the researchers observed the highest sensitivities in the Global Registry of Acute Coronary Events (ROC = 0.99; 95% CI, 0.89-1), Aujesky 2006 (n = 16,735; ROC = 0.97; 95% CI, 0.95-0.99), Simplified Pulmonary Embolism Severity Index (n = 26,610; ROC = 0.92; 95% CI, 0.89-0.94), Pulmonary Embolism Severity Index (n = 23,997; ROC = 0.89; 95% CI, 0.87-0.9), and European Society of Cardiology (n = 2,463; ROC = 0.88; 95% CI, 0.77-0.94).
The researchers acknowledged there were limitations to the study including the date of search initiation.
“Although the year 2000 could be viewed as somewhat arbitrary, we chose it because it marked the time at which evidence based guidelines incorporating the first, to our knowledge, well-done randomized trials of heparin and [vitamin K antagonists] became available,” the researchers wrote.
Disclosure: Kohn reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.