A Novel Tool for Predicting an Abnormal Echocardiogram in Patients with Pulmonary Embolism: The PEACE Score
Authors: Nour Al Jalbout, Irene Ma, Hamid Shokoohi, Kathleen McFadden, Christopher Kabrhel, Nicholas Giordano, Andrew Liteplo
Published in: Journal of Emergency Medicine, 2023 November 23
Conclusions:
- The PEACE criteria, encompassing six variables, effectively predict abnormal TTE in PE patients. This tool may help identify patients who are candidates for safe early discharge, optimizing hospital resource utilization and patient care.
Methods:
- Retrospective analysis within two academic emergency departments, focusing on adult PE patients who underwent TTE.
- The study aimed to create a prediction score for abnormal TTE findings, which included right ventricle (RV) dilatation/hypokinesis, septal flattening, right heart thrombus in transit, or ejection fraction < 50%.
- Variables considered were demographics, symptoms, CT RV strain, troponin T, and NTproBNP.
- Utilized stepwise logistic regression to pinpoint variables independently linked with abnormal TTE. Model performance was assessed using AUC.
Results:
- Out of 2235 patients, 530 were included; 297 (56%) had abnormal TTE.
- Six variables independently related to abnormal TTE: dyspnea, dizziness, troponin T ≥ 0.1 ng/mL, NTproBNP > 900 pg/mL, CT RV strain, and nonsubsegmental PE.
- The developed PEACE score, based on these six criteria, ranged from 0 to 7 and demonstrated high accuracy with an AUC of 0.80.
- A score of 1 had a 99.7% sensitivity for ruling out abnormalities, while a score ≥ 5 had a 98% specificity for indicating an abnormality.