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 p rediction rule (PEscore) by which PE can be diagnosed by easily obtainable and rapidly available investigations. Included were consecutive patients wi th a clinical suspicion of PE admitted to a community hospital. Risk factor s and clinical and instrumental investigations were registered. PE was diag nosed by angiography, scintigraphy, or autopsy. In 168 patients, PE was eit her 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 a nalysis, 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 s ubsequent cases. In these patients, the PEscore was 0.65 +/- 0.17 (diagnose d 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 assess ed. Calculation of the PEscore can be helpful in clinical decisions when PE is suspected. (C) 2000 Elsevier Science Ltd. All rights reserved.