Expanding outpatient eligibility using a narrow definition of cancer in the Pulmonary Embolism Severity Index

Q: What is the main purpose of this study?

To evaluate the effect of narrowing the cancer definition used in PESI and sPESI from “any” cancer to “active” cancer on outpatient eligibility.

Q: Did narrowing the cancer definition change 30-day outcomes?

No. Thirty-day adverse events among low-risk patients were rare (0.5%) and were similar between any-cancer and active-cancer groups.

Sep 23, 2026

Uploaded by mieayamfan

Guidelines recommend the Pulmonary Embolism (PE) Severity Index (PESI) or simplified PESI (sPESI) to identify low-risk patients potentially eligible for outpatient care. Cancer is a key high-scoring variable in both tools, yet its definition differs across studies: “any” cancer includes active/recent and remote/nonactive, whereas “active” cancer includes only active or recent disease. This study assessed how narrowing the cancer definition from any to active changes outpatient eligibility classification and subsequent 30-day adverse events.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Background

Objectives

Methods

Results

Conclusion

Introduction

Risk stratification tools and outpatient eligibility

Variability in cancer definitions

[https://doi.org/10.1016/j.rpth.2026.106869](https://doi.org/10.1016/j.rpth.2026.106869) BRIEF REPORT Expanding outpatient eligibility using a narrow definition of cancer in the Pulmonary Embolism Severity Index Aidan R. Campbell1 | Camille M. Smith1, 2 | Grace V. Heringer1, 3,4 | Javeria Khader5 | Madeline J. Somers1, 6 | Pierre-Marie Roy7 | David R. Vinson1, 5, 6, 8, 9 1Kaiser Permanente Clinical Research on Emergency Services and Treatments (CREST) Network, Pleasanton, California, USA 2University of California, Davis, California, USA 3California Northstate University College of Medicine, Elk Grove, California, USA 4Vituity, Department of Emergency Medicine, Sutter Davis Medical Center, Davis, California, USA 5Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California, USA 6Kaiser Permanente Northern California Division of Research, Pleasanton, California, USA 7Departments of Emergency Medicine and Vascular Medicine, University Hospital of Angers, Angers, France 8The Permanente Medical Group, Pleasanton, California, USA 9Department of Emergency Medicine, Kaiser Permanente Medical Center, Roseville, California, USA Correspondence David R. Vinson, Department of Emergency Medicine, UC Davis School of Medicine, 4301 X Street, Patient Support Services Bldg. (PSSB), Suite 2100, Sacramento, CA 95817, USA. Email: [drvinson@health.ucdavis.edu](drvinson@health.ucdavis.edu) Handling Editor: Professor Michael Makris 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%; P < .001). Findings were similar with sPESI, although smaller: 52.8% vs 47.0%; difference, 5.8%(95% CI, 4. 1% - 7. 9%; P < .001). Thirty-day outcomes among low-risk patients were rare (0.5%) and similar between groups. 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. KEYWORDS ambulatory care, cancer, outpatient, pulmonary embolism, retrospective studies, risk assessment © 2026 The Author(s). Published by Elsevier Inc. on behalf of International Society on Thrombosis and Haemostasis. This is an open access article under the CC BYNC-ND license ([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)). Res Pract Thromb Haemost. 2026;10:e106869 [www.rpthjournal.org](www.rpthjournal.org- 1 of 7)[-](www.rpthjournal.org- 1 of 7)[ 1 of 7](www.rpthjournal.org- 1 of 7) [https://doi.org/10.1016/j.rpth.2026.106869](https://doi.org/10.1016/j.rpth.2026.106869) 2 of 7 ■ CAMPBELL ET AL. Essentials • Risk scores can ident

FAQs

What is the main purpose of this study?

To evaluate the effect of narrowing the cancer definition used in PESI and sPESI from “any” cancer to “active” cancer on outpatient eligibility.

How was “active” cancer defined for scoring?

Active-cancer PESI accrued cancer points only for metastatic disease or diagnosis, treatment, or palliative care within 12 months.

Did narrowing the cancer definition change 30-day outcomes?

No. Thirty-day adverse events among low-risk patients were rare (0.5%) and were similar between any-cancer and active-cancer groups.

Sep 23, 2026

Uploaded by mieayamfan