The value of sPESI for risk stratification in patients with pulmonary embolism

Phil Wells, W. Frank Peacock, Gregory J. Fermann, Craig I. Coleman, Li Wang, Onur Baser, Jeff Schein, Concetta Crivera

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Introduction: Various risk stratification methods exist for patients with pulmonary embolism (PE). We used the simplified Pulmonary Embolism Severity Index (sPESI) as a risk-stratification method to understand the Veterans Health Administration (VHA) PE population. Materials and methods: Adult patients with ≥ 1 inpatient PE diagnosis (index date = discharge date) from October 2011–June 2015 as well as continuous enrollment for ≥ 12 months pre- and 3 months post-index date were included. We defined a sPESI score of 0 as low-risk (LRPE) and all others as high-risk (HRPE). Hospital-acquired complications (HACs) during the index hospitalization, 90-day follow-up PE-related outcomes, and health care utilization and costs were compared between HRPE and LRPE patients. Results: Of 6746 PE patients, 95.4% were men, 67.7% were white, and 22.0% were African American; LRPE occurred in 28.4% and HRPE in 71.6%. Relative to HRPE patients, LRPE patients had lower Charlson Comorbidity Index scores (1.0 vs. 3.4, p < 0.0001) and other baseline comorbidities, fewer HACs (11.4% vs. 20.0%, p < 0.0001), less bacterial pneumonia (10.6% vs. 22.3%, p < 0.0001), and shorter average inpatient lengths of stay (8.8 vs. 11.2 days, p < 0.0001) during the index hospitalization. During follow-up, LRPE patients had fewer PE-related outcomes of recurrent venous thromboembolism (4.4% vs. 6.0%, p = 0.0077), major bleeding (1.2% vs. 1.9%, p = 0.0382), and death (3.7% vs. 16.2%, p < 0.0001). LRPE patients had fewer inpatient but higher outpatient visits per patient, and lower total health care costs ($12,021 vs. $16,911, p < 0.0001) than HRPE patients. Conclusions: Using the sPESI score identifies a PE cohort with a lower clinical and economic burden.

Original languageEnglish (US)
Pages (from-to)149-157
Number of pages9
JournalJournal of Thrombosis and Thrombolysis
Volume48
Issue number1
DOIs
StatePublished - Jul 15 2019
Externally publishedYes

Keywords

  • Cost of illness
  • Pulmonary embolism
  • Trauma Severity Index
  • Veterans Health Administration

ASJC Scopus subject areas

  • Hematology
  • Cardiology and Cardiovascular Medicine

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