Pulse 110/min beats per min + 20 Systolic blood pressure <100 mmhg Respiratory rate 30 breaths per min + 20
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1 Online Supplement Impact of Relative Contraindications to Home Management in Emergency Department Patients with Low-Risk Pulmonary Embolism David R. Vinson, Carrieann E. Drenten, Jie Huang, J. Eileen Morley, Megan L. Anderson, Mary E. Reed, Daniel K. Nishijima, and Vincent Liu; on behalf of the KP CREST Network Table E1. The Pulmonary Embolism Severity Index Predictors Points* Demographic Characteristics Age + 1 per year Male sex + 10 Comorbid Illness Cancer (active or history of) + 30 Heart Failure (systolic or diastolic) + 10 Chronic Lung Disease (includes asthma) + 10 Clinical Findings Pulse 110/min beats per min + 20 Systolic blood pressure <100 mmhg + 30 Respiratory rate 30 breaths per min + 20 Temperature <36 C + 20 Altered mental status + 60 Arterial oxygen saturation <90% + 20 * A total point score for a given patient is obtained by summing the patient's age in years and the points for each applicable characteristic. Point scores correspond with the following classes that estimate escalating risks of 30-day mortality: 65 class I, very low risk; class II, low risk; class III, intermediate risk; class IV, high risk; >125 class V, very high risk. The worst vital signs are used Acute or pre-existing disorientation, lethargy, stupor, or coma With or without supplemental oxygenation
2 E2 Table E2. Programming used to facilitate investigator identification of 5-day and 30-day adverse outcomes in emergency department patients with acute pulmonary embolism Variable Programming source Definition Thrombolysis CLARITY ORDER_PROC CPT codes: Thrombectomy CLARITY ORDER_PROC CPT codes: Respiratory support Cardiac dysrhythmia with treatment Reception of vasopressors or inotropic medications Anatomically-defined major hemorrhage Non-specific bleeding diagnoses Nursing flowsheet CLARITY IP_FLWSHT_REC CLARITY IP_FLWSHT_MEAS Any inpatient diagnosis CLARITY Medication list ORDER_MED Medication list ORDER_MED Any emergency department or inpatient diagnosis CLARITY PAT_ENC_DX Any emergency department diagnosis or a primary inpatient diagnosis CLARITY PAT_ENC_DX Non-rebreather mask, bilevel positive airway pressure, continuous positive airway pressure, ventilator ICD-9 codes: , , 427.0, 427.2, 427.1, , , Intravenous amiodarone, procainamide, lidocaine, adenosine, ibutilide, vernakalant, digoxin, diltiazem, verapamil, esmolol, metoprolol, propranolol Intravenous dopamine, norepinephrine, epinephrine, dobutamine, milrinone, phenylephrine, vasopressin, isoproterenol ICD-9 codes: 430, 431, 432.0, 432.1, 432.9, 9, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 336.1, , 459.0, , , , , , , , , , , 423.0, 423.3, , ICD-9 codes: 456.8, 580.9, 596.7, 596.8, , , 626.2, 626.6, 626.8, 455.2, 455.5, 455.8, 456.0, 456.2, 459.0, , 530.7, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,
3 E3 Red blood transfusions Anemia Diagnostic imaging for possible recurrent venous thromboembolic disease Nursing flowsheet IP_FLWSHT_REC IP_FLWSHT_MEAS ORDER_PROC , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 569.3, , , , 577.8, 578.0, 578.1, 578.9, , , 784.7, 784.8, , Report dates of transfusion Report dates on which the serum hemoglobin ORDER_RESULTS value was <9 gm/dl ORDER_PROC CPT codes: 71275, 71260, 71270, 78579, 78580, 78582, 78584, 78585, 78586, 78587, 78588, 78591, 78593, 78594, 75743, 75746, 71555, 93970, CPT, Current Procedural Terminology; ICD-9, International Classification of Disease, Ninth edition
4 E4 Table E3. Risk factors for venous thromboembolism among emergency department patients with acute pulmonary embolism who are low risk on the Pulmonary Embolism Severity Index Venous Thromboembolism Risk Factor N=423 No (%) Body mass index (BMI) 30; or if BMI not 229 (54.1) reported, weight 120 kg Hospitalization overnight (within the prior 3 months) 86 (20.3) History of prior venous thromboembolism 75 (17.7) Surgery (within the prior 3 months) 74 (17.5) Bed rest, immobilization (e.g., cast), or paresis/paralysis beyond 48 hours in duration (within the prior month) 62 (14.7) Estrogen use (excluding vaginal application) 54 (12.8) Long ground or air travel beyond four hours in duration or air travel beyond 1500 miles (within the prior month) Smoking, active or recent quit (within the prior month) 47 (11.1) 40 (9.5) Auto-immune disease* 22 (5.2) Non-minimal trauma (within the prior 3 months) 19 (4.5) Inherited hypercoagulable state 12 (2.8) Heart failure 10 (2.4) Post-partum, post-miscarriage, post-ectopic pregnancy, or post-abortion (within the prior 6 weeks) 9 (2.1) Cancer, known or history 9 (2.1) Chronic obstructive lung disease 8 (1.9) Nephrotic syndrome 4 (0.9) Central venous catheterization (within the prior 3 months) 4 (0.9) Pregnancy 3 (0.7) Medical condition with hyperviscosity 2 (0.5) Acute sepsis diagnosis 2 (0.5)
5 E5 Acute stroke diagnosis 0 Human immunodeficiency virus 0 * Includes Crohn s disease (regional enteritis), ulcerative colitis, rheumatoid arthritis, systemic lupus erythematosus, Behcet disease, immune thrombocytopenic purpura, polymyositis, dermatomyositis, and polyarteritis nodosa Includes factor V Leiden deficiency, prothrombin gene mutation, antithrombin III deficiency, protein C or S deficiency, factor XIII mutation, familial dysfibrinogenemia, and antiphospholipid syndrome (lupus anticoagulant, anti-cardiolipin antibodies, anti-β2-glycoprotein 1 antibodies) Includes polycythemia, multiple myeloma, essential thrombocytosis, sickle cell anemia, paroxysmal nocturnal hemoglobinuria, and heparin-induced thrombocytopenia
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