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BMC Health Serv Res. 2016 Oct 22;16(1):610.

External validation of a multivariable claims-based rule for predicting in-hospital mortality and 30-day post-pulmonary embolism complications.

Author information

1
University of Connecticut School of Pharmacy, 69 North Eagleville Road, Storrs, CT, 06269, USA. craig.coleman@hhchealth.org.
2
Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
3
Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA.
4
Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
5
University of Connecticut School of Pharmacy, 69 North Eagleville Road, Storrs, CT, 06269, USA.
6
Optum, Eden Prairie, MN, USA.

Abstract

BACKGROUND:

Low-risk pulmonary embolism (PE) patients may be candidates for outpatient treatment or abbreviated hospital stay. There is a need for a claims-based prediction rule that payers/hospitals can use to risk stratify PE patients. We sought to validate the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) prediction rule for in-hospital and 30-day outcomes.

METHODS:

We used the Optum Research Database from 1/2008-3/2015 and included adults hospitalized for PE (415.1x in the primary position or secondary position when accompanied by a primary code for a PE complication) and having continuous medical and prescription coverage for ≥6-months prior and 3-months post-inclusion or until death. In-hospital and 30-day mortality and 30-day complications (recurrent venous thromboembolism, rehospitalization or death) were assessed and prognostic accuracies of IMPACT with 95 % confidence intervals (CIs) were calculated.

RESULTS:

In total, 47,531 PE patients were included. In-hospital and 30-day mortality occurred in 7.9 and 9.4 % of patients and 20.8 % experienced any complication within 30-days. Of the 19.5 % of patients classified as low-risk by IMPACT, 2.0 % died in-hospital, resulting in a sensitivity and specificity of 95.2 % (95 % CI, 94.4-95.8) and 20.7 % (95 % CI, 20.4-21.1). Only 1 additional low-risk patient died within 30-days of admission and 12.2 % experienced a complication, translating into a sensitivity and specificity of 95.9 % (95 % CI, 95.3-96.5) and 21.1 % (95 % CI, 20.7-21.5) for mortality and 88.5 % (95 % CI, 87.9-89.2) and 21.6 % (95 % CI, 21.2-22.0) for any complication.

CONCLUSION:

IMPACT had acceptable sensitivity for predicting in-hospital and 30-day mortality or complications and may be valuable for retrospective risk stratification of PE patients.

KEYWORDS:

Administrative claims; Mortality; Pulmonary embolism; Risk stratification

PMID:
27770814
PMCID:
PMC5075157
DOI:
10.1186/s12913-016-1855-y
[Indexed for MEDLINE]
Free PMC Article

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