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

J Thromb Thrombolysis. 2019 Jul;48(1):149-157. doi: 10.1007/s11239-019-01814-z.


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.

Keywords: Cost of illness; Pulmonary embolism; Trauma Severity Index; Veterans Health Administration.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Comorbidity
  • Female
  • Health Care Costs
  • Hemorrhage / chemically induced
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Mortality
  • Pulmonary Embolism / diagnosis*
  • Pulmonary Embolism / economics
  • Pulmonary Embolism / epidemiology
  • Recurrence
  • Risk Assessment / methods*
  • Veterans Health Services
  • Young Adult