title: External validation of a multivariable claims-based rule for predicting in-hospital mortality and 30-day post-pulmonary embolism complications.
abstract: Low-risk pulmonary embolism (PE) patients may be candidates for outpatient treatment or abbreviated hospital stay. There is a need for a claims-based prediction rule that payers/hospitals can use to risk stratify PE patients. We sought to validate the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) prediction rule for in-hospital and 30-day outcomes.
  
  
  
  We used the Optum Research Database from 1/2008-3/2015 and included adults hospitalized for PE (415.1x in the primary position or secondary position when accompanied by a primary code for a PE complication) and having continuous medical and prescription coverage for ≥6-months prior and 3-months post-inclusion or until death. In-hospital and 30-day mortality and 30-day complications (recurrent venous thromboembolism, rehospitalization or death) were assessed and prognostic accuracies of IMPACT with 95 % confidence intervals (CIs) were calculated.
  
  
  
  In total, 47,531 PE patients were included. In-hospital and 30-day mortality occurred in 7.9 and 9.4 % of patients and 20.8 % experienced any complication within 30-days. Of the 19.5 % of patients classified as low-risk by IMPACT, 2.0 % died in-hospital, resulting in a sensitivity and specificity of 95.2 % (95 % CI, 94.4-95.8) and 20.7 % (95 % CI, 20.4-21.1). Only 1 additional low-risk patient died within 30-days of admission and 12.2 % experienced a complication, translating into a sensitivity and specificity of 95.9 % (95 % CI, 95.3-96.5) and 21.1 % (95 % CI, 20.7-21.5) for mortality and 88.5 % (95 % CI, 87.9-89.2) and 21.6 % (95 % CI, 21.2-22.0) for any complication.
  
  
  
  IMPACT had acceptable sensitivity for predicting in-hospital and 30-day mortality or complications and may be valuable for retrospective risk stratification of PE patients.
authors: University of Connecticut School of Pharmacy, 69 North Eagleville Road, Storrs, CT, 06269, USA. craig.coleman@hhchealth.org.
authors: Craig I
authors: CI
authors: Coleman
authors: Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
authors: W Frank
authors: WF
authors: Peacock
authors: Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA.
authors: Gregory J
authors: GJ
authors: Fermann
authors: Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors: Concetta
authors: C
authors: Crivera
authors: University of Connecticut School of Pharmacy, 69 North Eagleville Road, Storrs, CT, 06269, USA.
authors: Erin R
authors: ER
authors: Weeda
authors: Optum, Eden Prairie, MN, USA.
authors: Michael
authors: M
authors: Hull
authors: Optum, Eden Prairie, MN, USA.
authors: Mary
authors: M
authors: DuCharme
authors: Optum, Eden Prairie, MN, USA.
authors: Laura
authors: L
authors: Becker
authors: Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors: Jeff R
authors: JR
authors: Schein
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D011655:Pulmonary Embolism / Q000150:complications / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014481:United States; D054556:Venous Thromboembolism / Q000150:complications / Q000401:mortality*
keywords: Administrative claims; Mortality; Pulmonary embolism; Risk stratification