title: Identification of Low-Risk Patients with Acute Symptomatic Pulmonary Embolism for Outpatient Therapy.
abstract: BACKGROUND
  Patients with acute symptomatic pulmonary embolism (PE) deemed to be at low risk for early complications might be candidates for partial or complete outpatient treatment.
  
  
  OBJECTIVE
  To develop and validate a clinical prediction rule that accurately identifies patients with PE and low risk of short-term complications and to compare its prognostic ability with two previously validated models (i.e., the Pulmonary Embolism Severity Index [PESI] and the Simplified PESI [sPESI])
  
  
  METHODS
  Multivariable logistic regression of a large international cohort of patients with PE prospectively enrolled in the RIETE (Registro Informatizado de la Enfermedad TromboEmbólica) registry.
  
  
  RESULTS
  All-cause mortality, recurrent PE, and major bleeding up to 10 days after PE diagnosis were determined. Of 18,707 eligible patients with acute symptomatic PE, 46 (0.25%) developed recurrent PE, 203 (1.09%) bled, and 471 (2.51%) died. Predictors included in the final model were chronic heart failure, recent immobilization, recent major bleeding, cancer, hypotension, tachycardia, hypoxemia, renal insufficiency, and abnormal platelet count. The area under receiver-operating characteristic curve was 0.77 (95% confidence interval [CI], 0.75-0.78) for the RIETE score, 0.72 (95% CI, 0.70-0.73) for PESI (P < 0.05), and 0.71 (95% CI, 0.69-0.73) for sPESI (P < 0.05). Our RIETE score outperformed the prognostic value of PESI in terms of net reclassification improvement (P < 0.001), integrated discrimination improvement (P < 0.001), and sPESI (net reclassification improvement, P < 0.001; integrated discrimination improvement, P < 0.001).
  
  
  CONCLUSIONS
  We built a new score, based on widely available variables, that can be used to identify patients with PE at low risk of short-term complications, assisting in triage and potentially shortening duration of hospital stay.
authors.affiliation: 1 Department of Internal Medicine, Hospital Universitario del Vinalopo, Elche, Alicante, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Maestre
authors.affiliation: 2 Department of Internal Medicine, Hospital General Universitario Santa Lucía, Murcia, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Trujillo-Santos
authors.affiliation: 3 Department of Internal Medicine, Hospital Universitario de Bellvitge, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Riera-Mestre
authors.affiliation: 4 Department of Pneumology, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Jiménez
authors.affiliation: 5 Department of Internal Medicine and Emergency Room, Ospedale Buonconsiglio Fatebenefratelli, Naples, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Di Micco
authors.affiliation: 6 Department of Internal Medicine, Hospital Infanta Leonor, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Bascuñana
authors.affiliation: 7 Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: Jerónimo Ramón
authors.initials: JR
authors.lastname: Vela
authors.affiliation: 8 Department of Internal Medicine, Consorcio Hospitalario Provincial de Castellón, Castellón, Spain.
authors.forename: Luísa
authors.initials: L
authors.lastname: Peris
authors.affiliation: 9 Department of Internal Medicine, Hospital Privado de Comunidad, Buenos Aires, Argentina; and.
authors.forename: Pablo César
authors.initials: PC
authors.lastname: Malfante
authors.affiliation: 10 Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Católica de Murcia, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Monreal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000925:Anticoagulants / Q000627:therapeutic use*; D003661:Decision Support Techniques; D005260:Female; D006470:Hemorrhage; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010045:Outpatients / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy*; D012372:ROC Curve; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index
chemical_list: D000925:Anticoagulants
keywords: anticoagulant therapy; bleeding; mortality; prognosis; pulmonary embolism