Validation of a Model for Identification of Patients at Intermediate to High Risk for Complications Associated With Acute Symptomatic Pulmonary Embolism

BACKGROUND For patients with acute symptomatic pulmonary embolism (PE), the Bova score classifies their risk for PE-related complications within 30 days after diagnosis. The original Bova score was derived from 2,874 normotensive patients with acute PE who participated in one of six prospective PE s...

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Veröffentlicht in:Chest 2015-07, Vol.148 (1), p.211-218
Hauptverfasser: Fernández, Carolina, MD, Bova, Carlo, MD, Sanchez, Olivier, PhD, Prandoni, Paolo, PhD, Lankeit, Mareike, MD, Konstantinides, Stavros, PhD, Vanni, Simone, MD, Fernández-Golfín, Covadonga, PhD, Yusen, Roger D., MD, Jiménez, David, PhD, FCCP
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container_end_page 218
container_issue 1
container_start_page 211
container_title Chest
container_volume 148
creator Fernández, Carolina, MD
Bova, Carlo, MD
Sanchez, Olivier, PhD
Prandoni, Paolo, PhD
Lankeit, Mareike, MD
Konstantinides, Stavros, PhD
Vanni, Simone, MD
Fernández-Golfín, Covadonga, PhD
Yusen, Roger D., MD
Jiménez, David, PhD, FCCP
description BACKGROUND For patients with acute symptomatic pulmonary embolism (PE), the Bova score classifies their risk for PE-related complications within 30 days after diagnosis. The original Bova score was derived from 2,874 normotensive patients with acute PE who participated in one of six prospective PE studies. METHODS We retrospectively assessed the validity of the Bova risk model in normotensive patients with acute PE diagnosed in an academic urban ED. Two clinician investigators used baseline data for the model's four prognostic variables to stratify patients into the three Bova risk stages (I-III) for 30-day PE-related complications. Intraclass correlation coefficient (ICC) and the κ statistic were used to assess interrater variability. RESULTS The Bova risk score classified the majority of the cohort of 1,083 patients into the lowest Bova risk stage (stage I, 80%; stage II, 15%; stage III, 5%), The primary end point occurred in 91 of the 1,083 patients (8.4%; 95% CI, 6.7%-10%) during the 30 days after PE diagnosis. Risk stage correlated with the PE-related complication rate (class I, 4.4%; class II, 18%; class III, 42%; ICC, 0.93 [95% CI, 0.92-0.94]; κ statistic, 0.80; P < .001), in-hospital complication rate (class I, 3.7%; class II, 15%; class III, 37%), and 30-day PE-related mortality (class I, 3.1%; class II, 6.8%; class III, 10.5%). CONCLUSIONS The Bova risk score accurately stratifies normotensive patients with acute PE into stages of increasing risk of PE-related complications that occur within 30 days of PE diagnosis.
doi_str_mv 10.1378/chest.14-2551
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The original Bova score was derived from 2,874 normotensive patients with acute PE who participated in one of six prospective PE studies. METHODS We retrospectively assessed the validity of the Bova risk model in normotensive patients with acute PE diagnosed in an academic urban ED. Two clinician investigators used baseline data for the model's four prognostic variables to stratify patients into the three Bova risk stages (I-III) for 30-day PE-related complications. Intraclass correlation coefficient (ICC) and the κ statistic were used to assess interrater variability. RESULTS The Bova risk score classified the majority of the cohort of 1,083 patients into the lowest Bova risk stage (stage I, 80%; stage II, 15%; stage III, 5%), The primary end point occurred in 91 of the 1,083 patients (8.4%; 95% CI, 6.7%-10%) during the 30 days after PE diagnosis. Risk stage correlated with the PE-related complication rate (class I, 4.4%; class II, 18%; class III, 42%; ICC, 0.93 [95% CI, 0.92-0.94]; κ statistic, 0.80; P &lt; .001), in-hospital complication rate (class I, 3.7%; class II, 15%; class III, 37%), and 30-day PE-related mortality (class I, 3.1%; class II, 6.8%; class III, 10.5%). CONCLUSIONS The Bova risk score accurately stratifies normotensive patients with acute PE into stages of increasing risk of PE-related complications that occur within 30 days of PE diagnosis.</description><identifier>ISSN: 0012-3692</identifier><identifier>EISSN: 1931-3543</identifier><identifier>DOI: 10.1378/chest.14-2551</identifier><identifier>PMID: 25633724</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute Disease ; Aged ; Aged, 80 and over ; Blood Pressure ; Female ; Heart Rate ; Humans ; Male ; Middle Aged ; Prognosis ; Pulmonary Embolism - complications ; Pulmonary Embolism - diagnosis ; Pulmonary Embolism - mortality ; Pulmonary/Respiratory ; Reproducibility of Results ; Retrospective Studies ; Risk Assessment ; Spain ; Troponin I - blood ; Ventricular Function, Right</subject><ispartof>Chest, 2015-07, Vol.148 (1), p.211-218</ispartof><rights>The American College of Chest Physicians</rights><rights>2015 The American College of Chest Physicians</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-6461fba863553322c41fc789b1ac70d41ecdd0dcfe618f6c0194124241f6c353</citedby><cites>FETCH-LOGICAL-c396t-6461fba863553322c41fc789b1ac70d41ecdd0dcfe618f6c0194124241f6c353</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25633724$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fernández, Carolina, MD</creatorcontrib><creatorcontrib>Bova, Carlo, MD</creatorcontrib><creatorcontrib>Sanchez, Olivier, PhD</creatorcontrib><creatorcontrib>Prandoni, Paolo, PhD</creatorcontrib><creatorcontrib>Lankeit, Mareike, MD</creatorcontrib><creatorcontrib>Konstantinides, Stavros, PhD</creatorcontrib><creatorcontrib>Vanni, Simone, MD</creatorcontrib><creatorcontrib>Fernández-Golfín, Covadonga, PhD</creatorcontrib><creatorcontrib>Yusen, Roger D., MD</creatorcontrib><creatorcontrib>Jiménez, David, PhD, FCCP</creatorcontrib><title>Validation of a Model for Identification of Patients at Intermediate to High Risk for Complications Associated With Acute Symptomatic Pulmonary Embolism</title><title>Chest</title><addtitle>Chest</addtitle><description>BACKGROUND For patients with acute symptomatic pulmonary embolism (PE), the Bova score classifies their risk for PE-related complications within 30 days after diagnosis. The original Bova score was derived from 2,874 normotensive patients with acute PE who participated in one of six prospective PE studies. METHODS We retrospectively assessed the validity of the Bova risk model in normotensive patients with acute PE diagnosed in an academic urban ED. Two clinician investigators used baseline data for the model's four prognostic variables to stratify patients into the three Bova risk stages (I-III) for 30-day PE-related complications. Intraclass correlation coefficient (ICC) and the κ statistic were used to assess interrater variability. RESULTS The Bova risk score classified the majority of the cohort of 1,083 patients into the lowest Bova risk stage (stage I, 80%; stage II, 15%; stage III, 5%), The primary end point occurred in 91 of the 1,083 patients (8.4%; 95% CI, 6.7%-10%) during the 30 days after PE diagnosis. Risk stage correlated with the PE-related complication rate (class I, 4.4%; class II, 18%; class III, 42%; ICC, 0.93 [95% CI, 0.92-0.94]; κ statistic, 0.80; P &lt; .001), in-hospital complication rate (class I, 3.7%; class II, 15%; class III, 37%), and 30-day PE-related mortality (class I, 3.1%; class II, 6.8%; class III, 10.5%). CONCLUSIONS The Bova risk score accurately stratifies normotensive patients with acute PE into stages of increasing risk of PE-related complications that occur within 30 days of PE diagnosis.</description><subject>Acute Disease</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Blood Pressure</subject><subject>Female</subject><subject>Heart Rate</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prognosis</subject><subject>Pulmonary Embolism - complications</subject><subject>Pulmonary Embolism - diagnosis</subject><subject>Pulmonary Embolism - mortality</subject><subject>Pulmonary/Respiratory</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Spain</subject><subject>Troponin I - blood</subject><subject>Ventricular Function, Right</subject><issn>0012-3692</issn><issn>1931-3543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1ks1uEzEUhS1ERUPpki3yks0UX9vjyWyQoqilkYpa0YouLcf2ELeecbA9SHkTHhdPErpAYuW_7xxdn3sReg_kAlgz_6Q3NuUL4BWta3iFZtAyqFjN2Ws0IwRoxURLT9HblJ5IOUMr3qBTWgvGGspn6Pd35Z1R2YUBhw4r_DUY63EXIl4ZO2TXOf3yeld25S5hlfFqyDb21jiVLc4BX7sfG_zNpee9dhn6rT8qE16kFPQEGvzo8gYv9FhE97t-m0NfGI3vRt-HQcUdvuzXwbvUv0MnnfLJnh_XM_RwdfmwvK5ubr-sloubSrNW5EpwAd1azQWra8Yo1Rw63czbNSjdEMPBamOI0Z0VMO-EJtByoJwWTGhWszP08WC7jeHnWKKUvUvaeq8GG8YkQbS8FZTt0eqA6hhSiraT2-j6UrMEIqdeyH0vJHA59aLwH47W47oE9UL_Db8AzQGw5X-_nI0y6ZKvLqFGq7M0wf3X-vM_Su3dUPL2z3Zn01MY41BCkyATlUTeT4MwzQHUNSHFjv0BqZuvtw</recordid><startdate>20150701</startdate><enddate>20150701</enddate><creator>Fernández, Carolina, MD</creator><creator>Bova, Carlo, MD</creator><creator>Sanchez, Olivier, PhD</creator><creator>Prandoni, Paolo, PhD</creator><creator>Lankeit, Mareike, MD</creator><creator>Konstantinides, Stavros, PhD</creator><creator>Vanni, Simone, MD</creator><creator>Fernández-Golfín, Covadonga, PhD</creator><creator>Yusen, Roger D., MD</creator><creator>Jiménez, David, PhD, FCCP</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150701</creationdate><title>Validation of a Model for Identification of Patients at Intermediate to High Risk for Complications Associated With Acute Symptomatic Pulmonary Embolism</title><author>Fernández, Carolina, MD ; Bova, Carlo, MD ; Sanchez, Olivier, PhD ; Prandoni, Paolo, PhD ; Lankeit, Mareike, MD ; Konstantinides, Stavros, PhD ; Vanni, Simone, MD ; Fernández-Golfín, Covadonga, PhD ; Yusen, Roger D., MD ; Jiménez, David, PhD, FCCP</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-6461fba863553322c41fc789b1ac70d41ecdd0dcfe618f6c0194124241f6c353</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Acute Disease</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Blood Pressure</topic><topic>Female</topic><topic>Heart Rate</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prognosis</topic><topic>Pulmonary Embolism - complications</topic><topic>Pulmonary Embolism - diagnosis</topic><topic>Pulmonary Embolism - mortality</topic><topic>Pulmonary/Respiratory</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Spain</topic><topic>Troponin I - blood</topic><topic>Ventricular Function, Right</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fernández, Carolina, MD</creatorcontrib><creatorcontrib>Bova, Carlo, MD</creatorcontrib><creatorcontrib>Sanchez, Olivier, PhD</creatorcontrib><creatorcontrib>Prandoni, Paolo, PhD</creatorcontrib><creatorcontrib>Lankeit, Mareike, MD</creatorcontrib><creatorcontrib>Konstantinides, Stavros, PhD</creatorcontrib><creatorcontrib>Vanni, Simone, MD</creatorcontrib><creatorcontrib>Fernández-Golfín, Covadonga, PhD</creatorcontrib><creatorcontrib>Yusen, Roger D., MD</creatorcontrib><creatorcontrib>Jiménez, David, PhD, FCCP</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Chest</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fernández, Carolina, MD</au><au>Bova, Carlo, MD</au><au>Sanchez, Olivier, PhD</au><au>Prandoni, Paolo, PhD</au><au>Lankeit, Mareike, MD</au><au>Konstantinides, Stavros, PhD</au><au>Vanni, Simone, MD</au><au>Fernández-Golfín, Covadonga, PhD</au><au>Yusen, Roger D., MD</au><au>Jiménez, David, PhD, FCCP</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Validation of a Model for Identification of Patients at Intermediate to High Risk for Complications Associated With Acute Symptomatic Pulmonary Embolism</atitle><jtitle>Chest</jtitle><addtitle>Chest</addtitle><date>2015-07-01</date><risdate>2015</risdate><volume>148</volume><issue>1</issue><spage>211</spage><epage>218</epage><pages>211-218</pages><issn>0012-3692</issn><eissn>1931-3543</eissn><abstract>BACKGROUND For patients with acute symptomatic pulmonary embolism (PE), the Bova score classifies their risk for PE-related complications within 30 days after diagnosis. The original Bova score was derived from 2,874 normotensive patients with acute PE who participated in one of six prospective PE studies. METHODS We retrospectively assessed the validity of the Bova risk model in normotensive patients with acute PE diagnosed in an academic urban ED. Two clinician investigators used baseline data for the model's four prognostic variables to stratify patients into the three Bova risk stages (I-III) for 30-day PE-related complications. Intraclass correlation coefficient (ICC) and the κ statistic were used to assess interrater variability. RESULTS The Bova risk score classified the majority of the cohort of 1,083 patients into the lowest Bova risk stage (stage I, 80%; stage II, 15%; stage III, 5%), The primary end point occurred in 91 of the 1,083 patients (8.4%; 95% CI, 6.7%-10%) during the 30 days after PE diagnosis. Risk stage correlated with the PE-related complication rate (class I, 4.4%; class II, 18%; class III, 42%; ICC, 0.93 [95% CI, 0.92-0.94]; κ statistic, 0.80; P &lt; .001), in-hospital complication rate (class I, 3.7%; class II, 15%; class III, 37%), and 30-day PE-related mortality (class I, 3.1%; class II, 6.8%; class III, 10.5%). CONCLUSIONS The Bova risk score accurately stratifies normotensive patients with acute PE into stages of increasing risk of PE-related complications that occur within 30 days of PE diagnosis.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25633724</pmid><doi>10.1378/chest.14-2551</doi><tpages>8</tpages></addata></record>
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subjects Acute Disease
Aged
Aged, 80 and over
Blood Pressure
Female
Heart Rate
Humans
Male
Middle Aged
Prognosis
Pulmonary Embolism - complications
Pulmonary Embolism - diagnosis
Pulmonary Embolism - mortality
Pulmonary/Respiratory
Reproducibility of Results
Retrospective Studies
Risk Assessment
Spain
Troponin I - blood
Ventricular Function, Right
title Validation of a Model for Identification of Patients at Intermediate to High Risk for Complications Associated With Acute Symptomatic Pulmonary Embolism
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