• Wendy Zondag, Paul L den Exter, Monique J T Crobach, Anneke Dolsma, Marjolein L Donker, Michiel Eijsvogel, Laura M Faber, Herman M A Hofstee, Kaasjager Karin A H KA, Marieke J H A Kruip, Geert Labots, Christian F Melissant, Michelle S G Sikkens, Menno V Huisman, and Hestia Study Investigators.
• Department of Thrombosis and Hemostasis, Leiden University Medical Centre LUMC, C-4-70, Postbus 9600, 2300 RC Leiden, The Netherlands. W.Zondag@lumc.nl
• Thromb. Haemost. 2013 Jan 1; 109 (1): 47-52.

AbstractThe aim of this study is to compare the performance of two clinical decision rules to select patients with acute pulmonary embolism (PE) for outpatient treatment: the Hestia criteria and the simplified Pulmonary Embolism Severity Index (sPESI). From 2008 to 2010, 468 patients with PE were triaged with the Hestia criteria for outpatient treatment: 247 PE patients were treated at home and 221 were treated as inpatients. The outcome of interest was all-cause 30-day mortality. In a post-hoc fashion, the sPESI items were scored and patients were classified according to the sPESI in low and high risk groups. Of the 247 patients treated at home, 189 (77%) patients were classified as low risk according to the sPESI and 58 patients (23%) as high risk. In total, 11 patients died during the first month; two patients treated at home and nine patients treated in-hospital. None of the patients treated at home died of fatal PE. Both the Hestia criteria and sPESI selected >50% of patients as low risk, with good sensitivity and negative predictive values for 30-day mortality: 82% and 99% for the Hestia criteria and 91% and 100% for the sPESI, respectively. The Hestia criteria and the sPESI classified different patients eligible for outpatient treatment, with similar low risks for 30-day mortality. This study suggests that the Hestia criteria may identify a proportion of high risk sPESI patiennts who can be safely treated at home, this however requires further validation.

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