title: Comparison of two methods for selection of out of hospital treatment in patients with acute pulmonary embolism.
abstract: The aim of this study is to compare the performance of two clinical decision rules to select patients with acute pulmonary embolism (PE) for outpatient treatment: the Hestia criteria and the simplified Pulmonary Embolism Severity Index (sPESI). From 2008 to 2010, 468 patients with PE were triaged with the Hestia criteria for outpatient treatment: 247 PE patients were treated at home and 221 were treated as inpatients. The outcome of interest was all-cause 30-day mortality. In a post-hoc fashion, the sPESI items were scored and patients were classified according to the sPESI in low and high risk groups. Of the 247 patients treated at home, 189 (77%) patients were classified as low risk according to the sPESI and 58 patients (23%) as high risk. In total, 11 patients died during the first month; two patients treated at home and nine patients treated in-hospital. None of the patients treated at home died of fatal PE. Both the Hestia criteria and sPESI selected >50% of patients as low risk, with good sensitivity and negative predictive values for 30-day mortality: 82% and 99% for the Hestia criteria and 91% and 100% for the sPESI, respectively. The Hestia criteria and the sPESI classified different patients eligible for outpatient treatment, with similar low risks for 30-day mortality. This study suggests that the Hestia criteria may identify a proportion of high risk sPESI patiennts who can be safely treated at home, this however requires further validation.
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Centre LUMC, C-4-70, Postbus 9600, 2300 RC Leiden, The Netherlands. W.Zondag@lumc.nl
authors.forename: Wendy
authors.initials: W
authors.lastname: Zondag
authors.forename: Paul L
authors.initials: PL
authors.lastname: den Exter
authors.forename: Monique J T
authors.initials: MJ
authors.lastname: Crobach
authors.forename: Anneke
authors.initials: A
authors.lastname: Dolsma
authors.forename: Marjolein L
authors.initials: ML
authors.lastname: Donker
authors.forename: Michiel
authors.initials: M
authors.lastname: Eijsvogel
authors.forename: Laura M
authors.initials: LM
authors.lastname: Faber
authors.forename: Herman M A
authors.initials: HM
authors.lastname: Hofstee
authors.forename: Karin A H
authors.initials: KA
authors.lastname: Kaasjager
authors.forename: Marieke J H A
authors.initials: MJ
authors.lastname: Kruip
authors.forename: Geert
authors.initials: G
authors.lastname: Labots
authors.forename: Christian F
authors.initials: CF
authors.lastname: Melissant
authors.forename: Michelle S G
authors.initials: MS
authors.lastname: Sikkens
authors.forename: Menno V
authors.initials: MV
authors.lastname: Huisman
mesh_terms: D000208:Acute Disease; D000553:Ambulatory Care; D000925:Anticoagulants / Q000627:therapeutic use*; D003661:Decision Support Techniques; D005260:Female; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D018579:Patient Selection; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000925:Anticoagulants