title: Does the Pulmonary Embolism Severity Index accurately identify low risk patients eligible for outpatient treatment?
abstract: BACKGROUND
  The pulmonary embolism severity index (PESI) and the recently derived simplified PESI prognostic model have been developed to estimate the risk of 30-day mortality in patients with acute PE. We sought to assess if the PESI and simplified PESI prognostic models can accurately identify adverse events and to determine the rates of events in patients treated as outpatients.
  
  
  METHODS
  A retrospective cohort study of patients with acute pulmonary embolism (PE) presenting at the Ottawa Hospital (Canada) was conducted between 1 January 2007 and 31 December 2008.
  
  
  RESULTS
  Two hundred and forty three patients were included. A total of 118 (48.6%) and 81 (33.3%) were classified as low risk patients using the original and simplified PESI prognostic models respectively. None of the low risk patients died within the 3months of follow-up. One hundred and fifteen (47.3%) patients were safely treated as outpatients with no deaths or bleeding episodes and only 1 recurrent event within the first 14days or after 30days of follow-up. Thirty four (29.6%) of these outpatients were classified as high risk patients according to the original PESI and 54 (47.0%) to the simplified PESI prognostic model.
  
  
  CONCLUSIONS
  Both PESI strategies accurately identify patients with acute PE who are at low risk and high risk for short-term adverse events. However, 30 to 47% of patients with acute PE and a high risk PESI score were safely managed as outpatients. Future research should be directed at developing tools that predict which patients would benefit from inpatient management.
authors: Department of General Practice, School for Public and Primary Care (CAPHRI) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands.
authors: Petra M G
authors: PM
authors: Erkens
authors: Esteban
authors: E
authors: Gandara
authors: Philip S
authors: PS
authors: Wells
authors: Alex Yi-Hao
authors: AY
authors: Shen
authors: Gauruv
authors: G
authors: Bose
authors: Gregoire
authors: G
authors: Le Gal
authors: Marc
authors: M
authors: Rodger
authors: Martin H
authors: MH
authors: Prins
authors: Marc
authors: M
authors: Carrier
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors