ArticleResearch and practice in thrombosis and haemostasis2026
Expanding outpatient eligibility using a narrow definition of cancer in the Pulmonary Embolism Severity Index.
Article in Research and practice in thrombosis and haemostasis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Guidelines recommend the Pulmonary Embolism (PE) Severity Index (PESI) or the simplified PESI (sPESI) to identify low-risk patients eligible for outpatient care. Cancer is a high-scoring variable in both scores, but definitions vary: "any" cancer (active/recent as well as remote/nonactive) vs "active" cancer (only active or recent). Objectives: This study evaluated the effect of narrowing the cancer definition (from any to active) on outpatient eligibility. Methods: We conducted a secondary analysis of a retrospective cohort study across 21 US community hospitals. Included were ambulatory adults diagnosed with PE in primary care who underwent vital sign measurements. Active-cancer PESI accrued cancer points only for metastatic disease or diagnosis, treatment, or palliative care within 12 months. We compared proportions of low-risk classification and 30-day adverse events (recurrent venous thromboembolism, major bleeding, and all-cause mortality) between any- and active-cancer definitions in both PESI and sPESI. Results: Among 636 included patients, 132 (20.8%) had any cancer and 49 (7.7%) had active cancer. Active-cancer PESI classified more patients as low risk than any-cancer PESI: 69.7% vs 61.9%; difference, 7.7% (95% CI, 5.8%-10.1%; Conclusion: An active-only cancer definition (vs any cancer) in PESI and sPESI classified a larger proportion of PE patients as low risk. No differences in 30-day outcomes were observed in this very low-risk cohort. Studies in higher-risk cohorts are needed.
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