Table 1.
Currently Available Prognostic Scores for the Selection of Low‐Risk Patients With PE
| Risk Score | Advantages | Disadvantages |
|---|---|---|
| PESI | The most well‐validated risk score in this context (including consistent prospective validation)61, 62 | Exclusive use of dichotomous variables may oversimplify prognostic assessment. |
| Large derivation sample | A significant percentage of patients assigned to the high‐risk category can still be safely managed as outpatients.28 | |
| Outperforms the Geneva score in prognostic assessment30 | Requires computation of a score based on 11 variables, each with a different weight | |
| Accurate in both high‐ and low‐risk patient detection28 | ||
| Serial calculation and a decision on potential discharge at the 24‐ to 48‐hour mark may be an even more accurate risk‐stratification strategy with higher certainty of safety.31 | ||
| Simplified PESI | Easier to use than original PESI score | Although applied to a group of patients with prospectively collected data, simplified PESI has not been validated in a prospective sample. |
| Similar63 or slightly lower29 accuracy as the original PESI in prognostic assessment | Exclusive use of dichotomous variables | |
| Accurately identifies patients at low risk for adverse events63 | ||
| Easily usable bedside prediction | ||
| Hestia criteria | Prospectively derived score34 | Small size of derivation sample |
| Accurately detects patients at low‐risk of adverse events | ||
| May identify a proportion of simplified PESI high‐risk patients who can be safely treated as outpatients35 | ||
| May identify a proportion of patients with RV dysfunction who can be safely treated as outpatients36 | ||
| Easily usable bedside prediction | ||
| Geneva | Useful for assessing clinical probability of pulmonary embolism64 | Variables have different weights, which may lead to miscalculations in an acute setting. |
| Easily usable bedside prediction | Primarily developed for diagnostic purposes | |
| Prognostic value consistently outperformed by PESI30, 65 | ||
| Simplified Geneva66 | Similar diagnostic accuracy of original Geneva score but easier to use | Developed for diagnostic purposes |
| Does not require arterial blood‐gas sample to be collected | Probably outperformed by PESI (although not directly compared) | |
| LR‐PED rule27 | The only score derived from a cohort of apparently low‐risk patients | Lack of proper validation (retrospective or prospective) |
| Detects truly low‐risk patients with very high accuracy | Small size of derivation sample | |
| The first score to demonstrate the importance of rhythm alongside heart rate33 | Requires a regression equation and a calculator | |
| GRACE37 | The most comprehensive risk score available; applicable to different clinical contexts | Lack of proper validation (retrospective or prospective) in the context of an acute PE |
| Detects truly low‐risk patients (GRACE score <113) with very high accuracy | Small size of derivation sample | |
| The first score to include ECG parameters | Requires a calculator | |
| Shock index | Very easy to calculate | Extremely reductive |
| Most patients are considered low risk | ||
| Limited accuracy in the selection of low‐risk patients67 | ||
| Agterof et al68 | Very easily applicable (only 4 variables) | Lack of proper validation (retrospective or prospective) |
| Very low 10‐day adverse event rate in low‐risk patients | Small size of derivation sample | |
| Uresandi et al69 | Prospective derivation in a multicenter registry | Lack of proper validation |
| High accuracy in the selection of low‐risk patients | Exclusion of admission hemodynamic parameters (although reliably explained by the authors) | |
| Included minor bleeding (complication with significant impact in patients' well‐being) | ||
| Easily usable bedside prediction |
Abbreviations: ECG, electrocardiographic; GRACE, Global Registry of Acute Cardiac Events; LR‐PED, Low‐Risk Pulmonary Embolism Decision; PE, pulmonary embolism; PESI, Pulmonary Embolism Severity Index; RV, right ventricular.