Multivariate analysis-based prediction rule for pulmonary embolism

The diagnosis of pulmonary embolism (PE)is still an unresolved problem. The aim of this prospective observational study was to derive and validate a prediction rule (PEscore) by which PE can be diagnosed by easily obtainable and rapidly available investigations. Included were consecutive patients with a clinical suspicion of PE admitted to a community hospital. Risk factors and clinical and instrumental investigations were registered. PE was diagnosed by angiography, scintigraphy, or autopsy. In 168 patients, PE was either diagnosed (angiography, n=28; autopsy, n=18) or excluded (angiography, n=12; scintigraphy, n=99; autopsy, n=11), Based on the results of clinical and instrumental findings, a PEscore was derived by a multiple regression analysis, calculated as: [0.29xproven leg vein thrombosis (0=no, 1=yes)] + [0.25xECG right heart strain (0=no, 1=yes)] + [0.22xneck vein distension (0=no, 1=yes)] + [0.20xdyspnoea (0=no, 1=yes)] + [0.13xsuspicious chest X-ray (0=no, 1=yes)] + [0.17 (constant)]. The PEscore was tested further in 139 subsequent cases. In these patients, the PEscore was 0.65 +/- 0.17 (diagnosed PE, n=47) and 0.18 +/- 0.17 (excluded PE, n=92), respectively (p=0.0001). Depending on a given PEscore: the level of probability of PE can be assessed. Calculation of the PEscore can be helpful in clinical decisions when PE is suspected. (C) 2000 Elsevier Science Ltd. All rights reserved.