JMIR Publications

ABSTRACT

Background:

Studies suggest that less than 4% of patients with pulmonary embolisms (PE) are managed in the outpatient setting. Strong evidence and multiple guidelines support use of the Pulmonary Embolism Severity Index (PESI) for identification of acute PE patients appropriate for outpatient management. However, calculating the PESI score can be inconvenient in a busy emergency department (ED). To facilitate integration into ED workflow, we created a 2023 EpicTM-compatible clinical decision support (CDS) tool that automatically calculates the PESI score in real-time with patients’ electronic health data (ePESI).

Objective:

The primary objectives of this study were to determine the overall accuracy of ePESI and its ability to correctly distinguish high- and low-risk PESI scores within the EpicTM 2023 software. The secondary objective was to identify variables that impact ePESI accuracy.

Methods:

We collected ePESI scores on 500 consecutive patients at least 18 years old who underwent a computerized tomography-PE (CT-PE) scan in the ED of our tertiary, academic health center between January 3 and February 15, 2023. We compared ePESI results to a PESI score calculated by two independent, medically-trained abstractors blinded to the ePESI and each other’s results. ePESI accuracy was calculated with binomial test. Odds ratio (OR) was calculated with logistic regression.

Results:

203 (40.6%) and 297 (59.4%) patients had low- and high-risk PESI scores, respectively. The ePESI exactly matched the calculated PESI in 394/500 cases, for an accuracy of 78.8% (95% CI 74.9-82.3%), and correctly identified low- vs. high-risk in 477/500 (95.4%) cases. The accuracy of the ePESI was higher for low-risk scores (OR=2.96, 0<0.0001) and lower when patients were without prior encounters in the health system (OR 0.42, p=0.0075).

Conclusions:

In this single center study, the ePESI was highly accurate in discriminating between low- and high-risk scores. The CDS should facilitate real-time identification of patients who may be candidates for outpatient PE management.