POMPE-C Tool for Pulmonary Embolism Mortality
Predicts mortality for cancer patients with PE.
Advice
- The POMPE-C score is a well designed and validated prediction rule for patients with known cancer and new PE. Larger prospective validation studies are required before it can be utilized to guide disposition and treatment.
- The purpose of this study was to set the groundwork for tools with aid in the management of cancer patients found to have incidental PE, as well as those diagnosed with PE who are low risk.
- Active vs. Inactive cancer may confusing in certain settings, however even inactive had good prediction in the POMPE-C model. (ROC AUC analysis was still 0.85 for inactive cancer with wide confidence intervals).
Management
- For those patients with a POMPE-C risk of mortality of of ≤5%:
- Overall risk of mortality is low. No patients in this group died in the study.
- Consider this group for outpatient management and anticoagulation therapy.
- For those patients with a POMPE-C mortality estimate >5%:
- Overall of mortality in this group was not low, but with a posterior probability of 0/50 (95% CI: 0-7%).
- 106 patients in this group survived >30 days.
- Consider this group for admission and management.
- For those patient with a POMPE-C score of >50%:
- Overall risk of mortality was very high with a posterior probability of 73% (95%CI: 46-95%).
- Consider this group admission and goals of care discussion.
Critical Actions
- No calculator should trump clinical gestalt. A clinically high risk patient should be managed as such, regardless of POMPE-C score.
- The POMPE-C is only meant for patients with cancer and for risk stratification after the non-incidental diagnosis of PE has been made.
- Additional pathology and comorbidities should not be overlooked in the setting of a low POMPE-C score.
- Never delay resuscitative efforts for risk stratification.