Most patients with pulmonary embolism (PE) do well, and outpatient management is becoming more common. Predicting which patients will have complications would be valuable in order to triage patients for discharge or admission to a ward or intensive care unit and for recanalization or simple anticoagulation. The previously derived Bova score (Eur Respir J 2014; 44:694) stratifies patients with PE and systolic blood pressure >90 mm Hg into risk groups by assigning points for four variables: hypotension (systolic blood pressure 90–100 mm Hg, 2 points), tachycardia (heart rate ≥110 beats per minute, 1 point), troponin elevation (2 points), and right ventricular dysfunction on computed tomography or echocardiography (2 points). Now, the investigators evaluated the score’s performance in a validation cohort of 1083 patients with PE and systolic blood pressure >90 mm Hg at an academic medical center in Spain.
The investigators assessed Bova scores and rates of PE-related complications, defined as death from PE, hemodynamic collapse, or recurrent nonfatal PE. Complications occurred in 8.4% of patients. The complication rate increased with increasing score: 4% in patients with a score ≤2 points, 18% in those with 3–4 points, and 42% in those with >4 points. The score had a sensitivity of 26% and specificity of 97% for predicting PE-related complications.
COMMENT
The Bova score was effective in stratifying patients into risk groups, but further research is needed to determine whether this stratification will be useful for clinical practice. Normotensive patients with PE can be safely managed as outpatients if they are not hypoxic and if they do not have right ventricular strain or elevated troponin.
