Clinical question: Is there a simplified risk prediction model to identify those with low risk pulmonary embolism (PE) who can be treated as outpatients?
Background: Existing prognostic models for patients with acute PE are dependent on comorbidities, which can be challenging to use in a scoring system. Models that make use of acute clinical variables to predict morbidity or mortality may be of greater clinical utility.
Study design: Retrospective chart review with derivation and validation analysis.
Setting: Tertiary care hospital in Chennai, India.
Synopsis: The authors identified 400 patients with acute PE who met inclusion criteria. Using logistic regression and readily accessible clinical variables previously shown to be associated with acute PE mortality, the authors created the HOPPE prediction score: heart rate, PaO2, systolic blood pressure, diastolic blood pressure, and ECG score. Each variable was classified into three groups and assigned a point value that could be summed to a cumulative 30-day mortality risk score. In the derivation and validation cohorts, the low, intermediate, and high HOPPE scores were associated with a 30-day mortality of 0%, 7.5-8.5%, and 18.2-18.8%, respectively, with similar trends for secondary outcomes including right ventricular dysfunction, nonfatal cardiogenic shock, and cardiorespiratory arrest.
In comparison with the previously validated PESI score, the HOPPE score had significantly higher sensitivity, specificity, and discriminative power. The conclusions from this study were limited by its single institutional design.
Bottom line: The HOPPE score provides a risk assessment tool to identify those patients with acute PE who are at lowest and highest risk for morbidity and mortality.
Citation: Subramanian M et al. Derivation and validation of a novel prediction model to identify low-risk patients with acute pulmonary embolism. Am J Cardiol. 2017;120(4):676-81.
Dr. Pizza is a hospitalist, Beth Israel Deaconess Medical Center, and instructor in medicine, Harvard Medical School, Boston.