PE risk stratification: which tool is best?

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    PE risk stratification: which tool is best?

     

    Your patient with a newly diagnosed PE hates hospitals.  He or she agrees to defer to your judgement about admission versus discharge home, but makes it clear they would prefer to go home if it is safe.  Which tool should you use to help you decide?

    Up until recently, there were no prospective studies comparing sPESI (simplified pulmonary embolism severity index) and Hestia, the leading risk stratification tools for PE.  Finally, in August 2018 (see reference below), a single center, prospective cohort study including 488 patients newly diagnosed with PE was published that compared the two scores head to head.

    Reassuringly, both scores identified similar numbers of low risk patients (sPESI 28%, Hestia 27%).  Interestingly, interobserver reliability was better with sPESI than with Hestia (disagreement in 1.2% patients versus 7.6% patients, respectively).  When looking at what criteria each score takes into consideration, this result makes sense because Hestia contains more subjective criteria (see below).

    The bottom line is that both scores identified similar numbers of low risk patients, but sPESI may have more interobserver reliability than Hestia.

     

    PESI:

    https://www.mdcalc.com/pulmonary-embolism-severity-index-pesi

     

    sPESI:

    https://www.mdcalc.com/simplified-pesi-pulmonary-embolism-severity-index

     

    Hestia Criteria:

    https://www.mdcalc.com/hestia-criteria-outpatient-pulmonary-embolism-treatment

     

    CHEST 2016 guidelines for PE:

    https://journal.chestnet.org/article/S0012-3692(15)00335-9/fulltext

     

    References:

    Accuracy and interobserver reliability of the simplified pulmonary embolism severity index versus the hestia criteria for patients with pulmonary embolism. Acad Emerg Med. 2018 Aug 29. doi: 10.1111/acem.13561.

    Antithrombotic Therapy for VTE Disease.  Kearon, Clive et al., CHEST, Volume 149, Issue 2, 315 – 352.

     

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