Comparison of 4 Acute Pulmonary Embolism Mortality Risk Scores in Patients Evaluated by Pulmonary Embolism Response Teams

Question How well do different risk assessment tools estimate 7- and 30-day mortality in patients with acute pulmonary embolism? Findings This cohort study of 416 patients with acute pulmonary embolism found that commonly used risk assessment tools have only moderate discriminative ability for 7- and 30-day mortality in patients with acute pulmonary embolism. Meaning These findings suggest that clinicians may need to integrate broad clinical information rather than relying on a single risk assessment tool to estimate mortality risk and determine management for patients with acute pulmonary embolism. Importance The risk of death from acute pulmonary embolism can range as high as 15%, depending on patient factors at initial presentation. Acute treatment decisions are largely based on an estimate of this mortality risk. Objective To assess the performance of risk assessment scores in a modern, US cohort of patients with acute pulmonary embolism. Design, Setting, and Participants This multicenter cohort study was conducted between October 2016 and October 2017 at 8 hospitals participating in the Pulmonary Embolism Response Team (PERT) Consortium registry. Included patients were adults who presented with acute pulmonary embolism and had sufficient information in the medical record to calculate risk scores. Data analysis was performed from March to May 2020. Main Outcomes and Measures All-cause mortality (7- and 30-day) and associated discrimination were assessed by the area under the receiver operator curve (AUC). Results Among 416 patients with acute pulmonary embolism (mean [SD] age, 61.3 [17.6] years; 207 men [49.8%]), 7-day mortality in the low-risk groups ranged from 1.3% (1 patient) to 3.1% (4 patients), whereas 30-day mortality ranged from 2.6% (1 patient) to 10.2% (13 patients). Among patients in the highest-risk groups, the 7-day mortality ranged from 7.0% (18 patients) to 16.3% (7 patients), whereas 30-day mortality ranged from 14.4% (37 patients) to 26.3% (26 patients). Each of the risk stratification tools had modest discrimination for 7-day mortality (AUC range, 0.616-0.666) with slightly lower discrimination for 30-day mortality (AUC range, 0.550-0.694). Conclusions and Relevance These findings suggest that commonly used risk tools for acute pulmonary embolism have modest estimating ability. Future studies to develop and validate better risk assessment tools are needed. This cohort study examines the performance of risk assessment scores among US patients with acute pulmonary embolism.