title: On the necessity of new decision-making methods for cancer-associated, symptomatic, pulmonary embolism.
abstract: BACKGROUND
  Acute symptomatic pulmonary embolism (PE) varies in its clinical manifestations in patients with cancer and entails specific issues. The objective is to assess the performance of five scores (PESI, sPESI, GPS, POMPE, and RIETE) and a clinical decision rule to predict 30-day mortality.
  
  
  METHODS
  This is an ambispective, observational, multicenter study that collected episodes of PE in patients with cancer from 13 Spanish centers. The main criterion for comparing scales was the c-indices and 95% confidence intervals (CIs) of the models for predicting 30-day mortality.
  
  
  RESULTS
  585 patients with acute symptomatic PE were recruited. The 30-day mortality rate was 21.3 (95% CI; 18.2-24.8%). The specific scales (POMPE-C and RIETE) were equally effective in discriminating prognosis (c-index of 0.775 and 0.757, respectively). None of these best performing scales was superior to the ECOG-PS with a c-index of 0.724. The remaining scores (PESI, sPESI, and GPS) performed worse, with c-indexes of 0.719, 0.705, and 0.722, respectively. The dichotomic "clinical decision rule" for ambulatory therapy was at least equally reliable in defining a low risk group: in the absence of all exclusion criteria, 30-day mortality was 2%, compared to 5% and 4% in the POMPE-C and RIETE low-risk categories, respectively.
  
  
  CONCLUSIONS
  The accuracy of the five scales examined was not high enough to rely on to predict 30-day mortality and none of them contribute significantly to qualitative clinical judgment.
authors.affiliation: H. Universitario Morales Meseguer, Murcia, Spain. Electronic address: alberto.carmonabayonas@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Carmona-Bayonas
authors.affiliation: H. Universitario Clinic, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Font
authors.affiliation: H. Universitario Central de Asturias, Oviedo, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Jiménez-Fonseca
authors.affiliation: Department of Physiology, Faculty of Medicine, University of Murcia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Fenoy
authors.affiliation: H. Universitario Virgen del Rocío, CIBER de Enfermedades Respiratorias, Seville, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Otero
authors.affiliation: Hospital Nisa-Aljarafe, Sevilla, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Beato
authors.affiliation: H. Universitario Morales Meseguer, Murcia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Plasencia
authors.affiliation: H. Universitario Vall D' Hebron, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Biosca
authors.affiliation: H. Universitario Clinic, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Sánchez
authors.affiliation: H. Universitario Clinic, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Benegas
authors.affiliation: H. Universitario Central de Asturias, Oviedo, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Calvo-Temprano
authors.affiliation: H. Universitario Vall D' Hebron, Barcelona, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Varona
authors.affiliation: H. Universitario Central de Asturias, Oviedo, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Faez
authors.affiliation: H. Universitario Morales Meseguer, Murcia, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Vicente
authors.affiliation: ICO Duran i Reynals, Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: de la Haba
authors.affiliation: ICO Duran i Reynals, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Antonio
authors.affiliation: Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain.
authors.forename: O
authors.initials: O
authors.lastname: Madridano
authors.affiliation: Hospital Universitario Insular de Gran Canaria, Gran Canaria, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Ramchandani
authors.affiliation: Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Castañón
authors.affiliation: Parc Sanitari Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.
authors.forename: P J
authors.initials: PJ
authors.lastname: Marchena
authors.affiliation: H. Santa Lucía, Cartagena, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Martínez
authors.affiliation: Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Martín
authors.affiliation: H. Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Marín
authors.affiliation: H. Universitario Morales Meseguer, Murcia, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Ayala de la Peña
authors.affiliation: H. Universitario Morales Meseguer, Murcia, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Vicente
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012306:Risk; D055815:Young Adult
keywords: Accuracy; Cancer; Clinical decision rule; Mortality; Prognostic scales; Pulmonary embolism; Risk