Safety of the 4PEPS in Patients With a Very Low Prevalence of Pulmonary Embolism-Need for More Than a Point Estimate-Reply.
(2021) JAMA cardiology — Vol. 6, n° 12, p. 1468-1469 (2021)
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- In Reply We thank Freund et al for their interest in our article1 and for their contribution to the discussion. The 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS) strategy leads to an overall very low false-negative rate, the upper limit of the 95% CI being below the threshold recommended by the Scientific and Standardization Committee of the International Society of Thrombosis and Hemostasis. However, they question its safety in the specific subgroup of patients with a very low clinical pretest probability (CPP), ie, those with a 4PEPS less than 0. Indeed, in the validation cohorts, the upper limit of the false-negative rate was higher than 2% for this subgroup of patients. We agree that, ideally, a very low failure rate should be confirmed in each subgroup for whom the rule-out criteria differed. However, we do not consider this subgroup analysis to invalidate our promising results.
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Roy, P.-M., Moumneh, T., & Penaloza-Baeza, A. (2021). Safety of the 4PEPS in Patients With a Very Low Prevalence of Pulmonary Embolism-Need for More Than a Point Estimate-Reply. JAMA cardiology, 6(12), 1468-1469. https://doi.org/10.1001/jamacardio.2021.4011 (Original work published 2021)