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01.12.2016 | Research | Ausgabe 1/2016 Open Access

Thrombosis Journal 1/2016

External validation of prognostic rules for early post-pulmonary embolism mortality: assessment of a claims-based and three clinical-based approaches

Thrombosis Journal > Ausgabe 1/2016
Erin R. Weeda, Christine G. Kohn, Gregory J. Fermann, W. Frank Peacock, Christopher Tanner, Daniel McGrath, Concetta Crivera, Jeff R. Schein, Craig I. Coleman
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12959-016-0081-5) contains supplementary material, which is available to authorized users.

Competing interest

The authors declare that they have no competing interests.

Authors’ contributions

Study concept and design: ERW, CGK, GJF, WFP, CC, JRS, CIC. Acquisition of data: ERW, CGK, CT, DM, CIC. Analysis and interpretation of data: ERW, CGK, GJF, WFP, CT, DM, CC, JRS, CIC. Drafting the manuscript: ERW, CGK, CT, DM, CIC. Critical Revision of the manuscript for important intellectual content: ERW, CGK, GJF, WFP, CT, DM, CC, JRS, CIC. Administrative, technical or material support: ERW, CGK, CIC. Study supervision: CIC. CIC had full access to all the study data and take full responsibility for the integrity of the data and the accuracy of the data analysis. All authors read and approved the final manuscript. The authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICJME) and were fully responsible for all content and editorial decisions, and were involved in all stages of manuscript development. All authors read and approved the final manuscript.



Studies show the In-hospital Mortality for Pulmonary embolism using Claims daTa (IMPACT) rule can accurately identify pulmonary embolism (PE) patients at low-risk of early mortality in a retrospective setting using only claims for the index admission. We sought to externally validate IMPACT, Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI) and Hestia for predicting early mortality.


We identified consecutive adults admitted for objectively-confirmed PE between 10/21/2010 and 5/12/2015. Patients undergoing thrombolysis/embolectomy within 48 h were excluded. All-cause in-hospital and 30 day mortality (using available Social Security Death Index data through January 2014) were assessed and prognostic accuracies of IMPACT, PESI, sPESI and Hestia were determined.


Twenty-one (2.6 %) of the 807 PE patients died before discharge. All rules classified 26.1–38.3 % of patients as low-risk for early mortality. Fatality among low-risk patients was 0 % (sPESI and Hestia), 0.4 % (IMPACT) and 0.6 % (PESI). IMPACT’s sensitivity was 95.2 % (95 % confidence interval [CI] = 74.1–99.8 %), and the sensitivities of clinical rules ranged from 91 (PESI)-100 % (sPESI and Hestia). Specificities of all rules ranged between 26.8 and 39.1 %. Of 573 consecutive patients in the 30 day mortality analysis, 33 (5.8 %) died. All rules classified 27.9–38.0 % of patients as low-risk, and fatality occurred in 0 (Hestia)-1.4 % (PESI) of low-risk patients. IMPACT’s sensitivity was 97.0 % (95%CI = 82.5–99.8 %), while sensitivities for clinical rules ranged from 91 (PESI)-100 % (Hestia). Specificities of rules ranged between 29.6 and 39.8 %.


In this analysis, IMPACT identified low-risk PE patients with similar accuracy as clinical rules. While not intended for prospective clinical decision-making, IMPACT appears useful for identification of low-risk PE patient in retrospective claims-based studies.
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