Test characteristics of clinical decision rules
| Sensitivity | Specificity | PPV | NPV | LR (+) | LR (−) | |
|---|---|---|---|---|---|---|
| PESI*(ref. 8) | ||||||
| Primary outcome | 71% (61–0.80%) | 58% (51–65%) | 47% (39–55%) | 80% (72–86%) | 1.71 (1.39–2.11) | 0.49 (0.35–0.68) |
| Severe outcome | 78% (58–91%) | 51% (45–57%) | 14% (09–20%) | 96% (91–98%) | 1.58 (1.25–2.01) | 0.44 (0.21–0.89) |
| 30-day mortality | 100% (74–100%) | 51% (45–56%) | 08% (04–13%) | 100% (97–100%) | 2.02 (1.80–2.27) | – |
| sPESI(ref. 12) | ||||||
| Primary outcome | 80% (71–87%) | 42% (35–49%) | 41% (34–49%) | 80% (71–88%) | 1.37 (1.18–1.60) | 0.48 (0.31–0.73) |
| Severe outcome | 81% (62–94%) | 36% (30–42%) | 11% (07–16%) | 95% (89–98%) | 1.27 (1.04–1.55) | 0.52 (0.23–1.16) |
| 30-day mortality | 100% (74–10%) | 36% (30–42%) | 06% (03–11%) | 100% (96–100%) | 1.56 (1.43–1.70) | – |
| Geneva(ref. 3) | ||||||
| Primary outcome | 39% (29–49%) | 84% (78–89%) | 55% (43–67%) | 73% (66–78%) | 2.38 (1.59–3.55) | 0.73 (0.62–0.87) |
| Severe outcome | 44% (25–65%) | 78% (73–83%) | 17% (09–28%) | 93% (88–96%) | 2.04 (1.27–3.29) | 0.71 (0.50–1.00) |
| 30-day mortality | 67% (35–90%) | 78% (73–83%) | 11% (05–21%) | 98% (96–100%) | 3.06 (1.94–4.84) | 0.43 (0.19–0.95) |
On receiver operating characteristic (ROC) curve analysis, areas under the curve (AUC) for the composite outcome were PESI=0.68, sPESI=0.69 and Geneva Prognostic Rule=0.64. For severe outcomes, the AUC were PESI=0.65, sPESI=0.67 and Geneva Prognostic Rule=0.59. For 30-day death, the AUC were PESI=0.84, sPESI=0.82 and Geneva Prognostic Rule=0.78.
Low risk was defined as PESI category I–II (≤85 points).8 *PESI categories are I: ≤65 points; II: 66–85 points; III: 86–105 points; IV: 106–125 points and V: ≥126 points. Low-risk sPESI was defined as <1 point.12 Low-risk Geneva Prognostic Rule was defined as ≤2 points.3
Positive and negative predictive values were based on the prevalence in our study sample.
LR, likelihood ratio; NPV, negative predictive value; PESI, pulmonary embolism severity index; PPV, positive predictive value; sPESI, simplified pulmonary embolism severity index.