title: External validation of a claims-based and clinical approach for predicting post-pulmonary embolism outcomes among United States veterans.
abstract: The In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) rule can accurately identify pulmonary embolism (PE) patients at low risk of early complications using claims data. We sought to externally validate the IMPACT and simplified Pulmonary Embolism Severity Index (sPESI) tools for predicting all-cause mortality and readmission. We used Veteran Health Administration data (10/1/2010-9/30/2015) to identify adults with ≥1 inpatient diagnosis code for acute PE, ≥12 months continuous medical and pharmacy benefits prior to the index PE, ≥90 days of post-event follow-up (unless death occurred) and ≥1 claim for an anticoagulant during the index PE stay. Prognostic accuracies of IMPACT and sPESI for 30- and 90-day all-cause mortality and 90-day readmission were estimated. Of 6,746 PE patients, 7.5 and 12.6% died at 30 and 90 days. Within 90 days, 20.1% were readmitted for any reason. Hospitalization for recurrent VTE and major bleeding occurred in 5.6 and 1.7% of patients. IMPACT classified 15.2% as low risk, while 28.4% were low risk per sPESI. Both tools displayed sensitivity >90% and negative predictive values (NPVs) >97% for 30-day mortality, but low specificity (range 16.2-30.0) and positive predictive values (PPVs) (range 8.7-9.5); with similar results observed for 90-day mortality. IMPACT's sensitivity for all-cause readmission was numerically higher than sPESI (88.2 vs. 79.0%), but both had comparable NPVs (85.1 vs. 84.2%). Similar trends were observed for VTE or major bleeding readmissions. IMPACT classified patients for post-PE outcomes with similar accuracy as sPESI. IMPACT appears useful for identifying PE patients at low risk for early mortality or readmission in claims-based studies.
authors.affiliation: School of Pharmacy, University of Saint Joseph, Hartford, CT, USA.
authors.forename: Christine G
authors.initials: CG
authors.lastname: Kohn
authors.affiliation: School of Pharmacy, University of Connecticut, 69 North Eagleville Road, Unit 3092, Storrs, CT, 06269, USA.
authors.forename: Erin R
authors.initials: ER
authors.lastname: Weeda
authors.affiliation: School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Neela
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, ON, USA.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Wells
authors.affiliation: Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Fermann
authors.affiliation: STATinMed Research, Plano, TX, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: STATinMed Research, Plano, TX, USA.|Department of Internal Medicine, Columbia University, New York, NY, USA.
authors.forename: Onur
authors.initials: O
authors.lastname: Baser
authors.affiliation: Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: Jeff R
authors.initials: JR
authors.lastname: Schein
authors.affiliation: Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: Concetta
authors.initials: C
authors.lastname: Crivera
authors.affiliation: School of Pharmacy, University of Connecticut, 69 North Eagleville Road, Unit 3092, Storrs, CT, 06269, USA. craig.coleman@hhchealth.org.
authors.forename: Craig I
authors.initials: CI
authors.lastname: Coleman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007345:Insurance Claim Review / Q000592:standards*; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D018570:Risk Assessment / Q000379:methods* / Q000592:standards; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000458:organization & administration / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data*
keywords: Administrative claim; Mortality; Prognosis; Pulmonary embolism; Risk assessment; Severity of illness index