Background: Prognostic assessment is important for the management of patients with pulmonary embolism (PE). A number of CPRs have been proposed for stratifying PE mortality risk. Aim of this systematic review is to assess the performance of prognostic clinical prediction rules (CPRs) in identifying low-risk PE.
Methods: MEDLINE and EMBASE databases were systematically searched until August 2011. Derivation and validation studies that assessed the performance of prognostic CPRs in predicting adverse events-risk in PE patients were included. Weighted mean proportion and 95% confidence intervals (CIs) of adverse events were then calculated and pooled using a fixed and a random-effects model. Statistical heterogeneity was evaluated through the use of I(2) statistics.
Results: Of 1125 references in the original search, 33 relevant articles were included. Nine CPRs were assessed in 37 cohorts, for a total of 35,518 patients. Pulmonary Embolism Severity Index and prognostic Geneva CPR were investigated in 22 and 6 cohorts, respectively. Eleven (29.7%) cohorts were of high quality. Median follow-up was 30 days. In low-risk PE patients, pooled short-term mortality (within 14 days or less) was 0.7% (95% CI 0.3-1.1%, random-effects model; I² = 49.6%), 30-day mortality was 1.7% (95% CI 1.1-2.3%, random-effects model; I² = 82.4%), and 90-day mortality was 2.2% (95% CI 1.2-3.4%, random-effects model; I² = 59.8%).
Conclusions: Prognostic CPRs efficiently identify PE patients at low risk of mortality. Before implementing prognostic CPRs in the routine care of PE patients, well-designed management studies are warranted. © 2012 International Society on Thrombosis and Haemostasis.
Authors: Squizzato A, Donadini MP, Galli L, Dentali F, Aujesky D, Ageno W
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