The value of sPESI for risk stratification in patients with pulmonary embolism

  • Phil Wells
  • W. Frank Peacock
  • Gregory J. Fermann
  • Craig I. Coleman
  • Li WangEmail author
  • Onur Baser
  • Jeff Schein
  • Concetta Crivera



Various risk stratification methods exist for patients with pulmonary embolism (PE). We used the simplified Pulmonary Embolism Severity Index (sPESI) as a risk-stratification method to understand the Veterans Health Administration (VHA) PE population.

Materials and methods

Adult patients with ≥ 1 inpatient PE diagnosis (index date = discharge date) from October 2011–June 2015 as well as continuous enrollment for ≥ 12 months pre- and 3 months post-index date were included. We defined a sPESI score of 0 as low-risk (LRPE) and all others as high-risk (HRPE). Hospital-acquired complications (HACs) during the index hospitalization, 90-day follow-up PE-related outcomes, and health care utilization and costs were compared between HRPE and LRPE patients.


Of 6746 PE patients, 95.4% were men, 67.7% were white, and 22.0% were African American; LRPE occurred in 28.4% and HRPE in 71.6%. Relative to HRPE patients, LRPE patients had lower Charlson Comorbidity Index scores (1.0 vs. 3.4, p < 0.0001) and other baseline comorbidities, fewer HACs (11.4% vs. 20.0%, p < 0.0001), less bacterial pneumonia (10.6% vs. 22.3%, p < 0.0001), and shorter average inpatient lengths of stay (8.8 vs. 11.2 days, p < 0.0001) during the index hospitalization. During follow-up, LRPE patients had fewer PE-related outcomes of recurrent venous thromboembolism (4.4% vs. 6.0%, p = 0.0077), major bleeding (1.2% vs. 1.9%, p = 0.0382), and death (3.7% vs. 16.2%, p < 0.0001). LRPE patients had fewer inpatient but higher outpatient visits per patient, and lower total health care costs ($12,021 vs. $16,911, p < 0.0001) than HRPE patients.


Using the sPESI score identifies a PE cohort with a lower clinical and economic burden.


Pulmonary embolism Trauma Severity Index Cost of illness Veterans Health Administration 



Charlson Comorbidity Index


Computed tomography angiography


Deep vein thrombosis




European Society of Cardiology


Hospital-acquired complication


High-risk pulmonary embolism


Health care resource utilization


International Classification of Diseases, 9th Revision, Clinical Modification


In-hospital mortality for pulmonary embolism using claims data


Low-molecular-weight heparin


Length of stay


Low-risk pulmonary embolism


Left ventricular


Novel oral anticoagulant


Pulmonary embolism


Statistical analysis software


Standard deviation


Simplified Pulmonary Embolism Severity Index


Standardized difference


Unfractionated heparin


Veterans Health Administration


Lung ventilation/perfusion


Venous thromboembolism



This study was funded by Janssen Scientific Affairs, LLC.

Compliance with ethical standards

Conflict of interest

WFP has received grants from Abbott, Alere, Banyan, Cardiorentis, Janssen, Portola, Pfizer, Roche, and ZS Pharma; is a consultant to Alere, Beckman, Boehringer-Ingelheim, Cardiorentis, Instrument Labs, Janssen, Phillips, Portola, Prevencio, Singulex, The Medicine’s Company, and ZS Pharma; and also has ownership interests at the Comprehensive Research Associate LLC, Emergencies in Medicine LLC. CIC has received grant funding and consulting fees from Janssen Scientific Affairs, LLC, Raritan, NJ and Bayer Pharma AG, Berlin, Germany. PW receives speaker fees from Bayer Healthcare and Daiichi Sankyo, writing committee fees from Itreas, and grant support fees from Pfizer/BMS. GJF has received research support from Novartis, Siemens, Pfizer, Portola, and PCORI; has advised Janssen Scientific Affairs, LLC; and receives speaker fees from Janssen. CC and JS and are employees of Janssen Scientific Affairs. LW and OB are employees of STATinMED Research, which is a paid consultant to Janssen Scientific Affairs.

Supplementary material

11239_2019_1814_MOESM1_ESM.docx (123 kb)
Supplementary material 1 (DOCX 123 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.University of Ottawa and the Ottawa Hospital Research InstituteOttawaCanada
  2. 2.Baylor College of MedicineHoustonUSA
  3. 3.University of CincinnatiCincinnatiUSA
  4. 4.University of ConnecticutStorrsUSA
  5. 5.STATinMED Research, Analytic ResearchPlanoUSA
  6. 6.Internal MedicineUniversity of MichiganAnn ArborUSA
  7. 7.STATinMED Research, Health Economics & Outcomes ResearchNew YorkUSA
  8. 8.Janssen Scientific Affairs, LLCTitusvilleUSA

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