Emergency management of incidental pulmonary embolism (IPE)

Emergency Cancer Care

Table 2 Risk assessment models developed for cancer-related pulmonary embolism

POMPE-C [38]	RIETE [36]		EPIPHANY Index [40, 41]			Workup scenarios (4S rule) [39]
Patient weight	Metastatic disease	+ 4	Clinical decision rule**	Presence ≥ 1 vs. none			TA-UPE	SPE	UPE-S
Respiratory rate (breath/min)^*	Immobilisation	+ 2	ECOG performance status scale	≥ 2 vs. < 2		Setting at PE diagnosis	Outpatient	In/outpatient	In/outpatient
Oxygen saturation^$	Age > 80 years	+ 1	PE-specific symptoms	Yes/no		PE suspicion	No	Yes	No
Heart rate > 100 bpm	Heart rate ≥ 110 bpm	+ 1	Pulse oximetry	SaO₂ < 90% vs. ≥ 90%		Vital signs	Normal	Any	Any
Altered mental status^&	Systolic BP < 100 mmHg	+ 1	Tumour response assessment***			Symptoms	No	Yes	Yes
Respiratory distress^Φ	Body weight < 60 kg	+ 1	Surgery of the primary tumour	Yes/no
Do not resuscitate status^¢
Unilateral limb swelling
Risk stratification	Risk class	30-day mortality	Tree modelling risk score°	15-day serious complications	Mortality	30-day mortality
30-day death probability according to math calculation	Class 1: low-risk < 2	0–4%	Low-risk	1.6%	0.3%		TA-UPE	SPE	UPE-S
	Class 2: intermediate-risk 2–4		Intermediate-risk	9.4%	6.1%		3%	21%	20%
	Class 3: high-risk 5–7		High-risk	30.6%	17.1%
	Class 4: Very high-risk > 7	20–30%				No difference in MB or recurrence of VTE within 90 days of follow-up

BP blood pressure, bpm beats per minute, MB major bleeding, PE pulmonary embolism, VTE venous thromboembolism, TA-UPE truly asymptomatic and unsuspected PE, SPE suspected PE, UPE-S unsuspected PE with symptoms
*Highest documented respiratory rate within previous 6 h
^$Most recent pulse oximetry measured in room air
^&Acute impairment in consciousness, new disorientation, delirium or confusion
^ΦDyspnea or increased work for breathing
^¢Written or verbal desire of the patient not to be resuscitated
^**Adaptation of Hestia’s exclusion criteria
^***Progressive disease, unknown/not evaluated disease, complete or partial response, stable or no evidence of disease
°Within 15 days from PE

ISSN: 2731-4790