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Clin Exp Emerg Med > Epub ahead of print
doi: https://doi.org/10.15441/ceem.22.369    [Epub ahead of print]
Predicting in-hospital mortality in pulmonary embolism patients: development and external validation of the PATHOS score
Michele Domenico Spampinato1,2 , Marcello Covino3 , Angelina Passaro1 , Marcello Benedetto1,2, Luca D’Angelo1,2, Giorgio Galizia1,2, Irma Sofia Fabbri1,2, Teresa Pagano1,2, Andrea Portoraro1,2, Matteo Guarino1,2 , Rita Previati4, Gianluca Tullo3, Antonio Gasbarrini5 , Roberto De Giorgio1,2 , Francesco Franceschi3
1Department of Translational Medicine, University of Ferrara, Ferrara, Italy
2University of Ferrara School of Emergency Medicine, Ferrara, Italy
3Department of Emergency Medicine, Gemelli University Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy
4Department of Emergency Medicine, St. Anna Hospital, Ferrara, Italy
5Department of Internal Medicine, Gemelli University Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy
Correspondence  Roberto De Giorgio Email: dgrrrt@unife.it
Received: August 23, 2022. Revised: October 6, 2022.  Accepted: October 27, 2022. Published online: November 17, 2022.
*The first two authors contributed equally to this study
According to the 2019 European Society of Cardiology (ESC) guidelines on pulmonary embolism (PE), prognosis is calculated using the Pulmonary Embolism Severity Index (PESI), a complex score with debated validity, or simplified PESI (sPESI). We have developed and validated a new risk score for in-hospital mortality (IHM) of patients with PE in the emergency department.
This retrospective, dual-center cohort study was conducted in the emergency departments of two third-level university hospitals. Patients aged >18 years with a contrast-enhanced computed tomography-confirmed PE were included. Clinical variables and laboratory tests were evaluated blindly to IHM. Multivariable logistic regression was performed to identify the new score’s predictors, and the new score was compared with the PESI, sPESI, and shock index.
A total of 1,358 patients were included in this study: 586 in the derivation cohort and 772 in the validation cohort, with a global 10.6% of IHM. The PATHOS scores were developed using independent variables to predict mortality: platelet count, age, troponin, heart rate, oxygenation, and systolic blood pressure. The PATHOS score showed good calibration and high discrimination, with an area under the receiver operating characteristics curve of 0.83 (95% confidence interval [CI], 0.77–0.89) in the derivation population and 0.74 (95% CI, 0.68–0.80) in the validation cohort, which is significantly higher than the PESI, sPESI, and shock index in both cohorts (P<0.01 for all comparisons).
PATHOS is a simple and effective prognostic score for predicting IHM in patients with PE in an emergency setting.
Keywords: Pulmonary embolism; Prognosis; Clinical prediction rules; Emergency medical services
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