Use of pulse oximetry to predict in-hospital complications in normotensive patients with pulmonary embolism

Jeffrey A. Kline, Jackeline Hernandez-Nino, Craig D. Newgard, Dana N. Cowles, Raymond E. Jackson, D. Mark Courtney

Research output: Contribution to journalArticle

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Abstract

PURPOSE: A simple method is needed to risk stratify normotensive patients with pulmonary embolism. We studied whether bedside clinical data can predict in-hospital complications from pulmonary embolism. METHODS: We performed a multicenter derivation phase, followed by validation in a single center. All patients were normotensive; the diagnosis of pulmonary embolism was established by objective imaging. Classification and regression analysis was performed to derive a decision tree from 27 parameters recorded from 207 patients. The validation study was conducted on a separate group of 96 patients to determine the derived criterion's diagnostic accuracy for in-hospital complications (cardiogenic shock, respiratory failure, or death). RESULTS: Mortality in the derivation phase was 4% (n = 8) at 24 hours and 10% (n = 21) at 30 days. A room-air pulse oximetry reading <95% was the most important predictor of death; mortality was 2% (95% confidence interval [CI]: 0% to 6%) in patients with pulse oximetry ≥95% versus 20% (95% CI: 12% to 29%) with pulse oximetry <95%. In the validation phase, the room-air pulse oximetry was <95% at the time of diagnosis in 9 of 10 patients who developed an in-hospital complication (sensitivity, 90%) and ≥95% in 55 of 86 patients without complications (specificity, 64%). CONCLUSION: Mortality from pulmonary embolism in normotensive patients is high. A room-air pulse oximetry reading ≥95% at diagnosis is associated with a significantly lower probability of in-hospital complications from pulmonary embolism.

Original languageEnglish (US)
Pages (from-to)203-208
Number of pages6
JournalAmerican Journal of Medicine
Volume115
Issue number3
DOIs
StatePublished - Aug 15 2003
Externally publishedYes

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Oximetry
Pulmonary Embolism
Air
Mortality
Reading
Confidence Intervals
Decision Trees
Cardiogenic Shock
Validation Studies
Respiratory Insufficiency
Regression Analysis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Use of pulse oximetry to predict in-hospital complications in normotensive patients with pulmonary embolism. / Kline, Jeffrey A.; Hernandez-Nino, Jackeline; Newgard, Craig D.; Cowles, Dana N.; Jackson, Raymond E.; Courtney, D. Mark.

In: American Journal of Medicine, Vol. 115, No. 3, 15.08.2003, p. 203-208.

Research output: Contribution to journalArticle

Kline, Jeffrey A. ; Hernandez-Nino, Jackeline ; Newgard, Craig D. ; Cowles, Dana N. ; Jackson, Raymond E. ; Courtney, D. Mark. / Use of pulse oximetry to predict in-hospital complications in normotensive patients with pulmonary embolism. In: American Journal of Medicine. 2003 ; Vol. 115, No. 3. pp. 203-208.
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N2 - PURPOSE: A simple method is needed to risk stratify normotensive patients with pulmonary embolism. We studied whether bedside clinical data can predict in-hospital complications from pulmonary embolism. METHODS: We performed a multicenter derivation phase, followed by validation in a single center. All patients were normotensive; the diagnosis of pulmonary embolism was established by objective imaging. Classification and regression analysis was performed to derive a decision tree from 27 parameters recorded from 207 patients. The validation study was conducted on a separate group of 96 patients to determine the derived criterion's diagnostic accuracy for in-hospital complications (cardiogenic shock, respiratory failure, or death). RESULTS: Mortality in the derivation phase was 4% (n = 8) at 24 hours and 10% (n = 21) at 30 days. A room-air pulse oximetry reading <95% was the most important predictor of death; mortality was 2% (95% confidence interval [CI]: 0% to 6%) in patients with pulse oximetry ≥95% versus 20% (95% CI: 12% to 29%) with pulse oximetry <95%. In the validation phase, the room-air pulse oximetry was <95% at the time of diagnosis in 9 of 10 patients who developed an in-hospital complication (sensitivity, 90%) and ≥95% in 55 of 86 patients without complications (specificity, 64%). CONCLUSION: Mortality from pulmonary embolism in normotensive patients is high. A room-air pulse oximetry reading ≥95% at diagnosis is associated with a significantly lower probability of in-hospital complications from pulmonary embolism.

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