TY - JOUR
T1 - ISTH definition of pulmonary embolism-related death and classification of the cause of death in venous thromboembolism studies: Validation in an autopsy cohort
AU - Tritschler, Tobias
AU - Salvatore, Steven P.
AU - Kahn, Susan R.
AU - Garcia, David
AU - Delluc, Aurélien
AU - Kraaijpoel, Noémie
AU - Langlois, Nicole
AU - Girard, Philippe
AU - le Gal, Grégoire
N1 - Funding Information: Tobias Tritschler, Susan R. Kahn, Aurélien Delluc, Noémie Langlois, and Grégoire Le Gal are members of the Canadian Venous Thromboembolism Research Network (CanVECTOR); the Network received grant funding from the Canadian Institutes of Health Research (Funding Reference: CDT‐142654). Tobias Tritschler's research was supported by an Early Postdoc. Mobility Award from the Swiss National Science Foundation (SNSF P2ZHP3_177999) and Fellowship Award from the CanVECTOR Network. Susan R. Kahn holds a Tier 1 Canada Research Chair in venous thromboembolism. Aurélien Delluc receives research salary support from the Department of Medicine, University of Ottawa. Grégoire Le Gal holds a mid‐career clinician scientist award from the Heart and Stroke Foundation of Ontario, and the Chair on the Diagnosis of Venous Thromboembolism, Department of Medicine, University of Ottawa. Publisher Copyright: © 2021 International Society on Thrombosis and Haemostasis
PY - 2021/10
Y1 - 2021/10
N2 - Background: The International Society on Thrombosis and Haemostasis (ISTH)’s Scientific and Standardization Committee (SSC) recently proposed a definition of pulmonary embolism (PE)-related death. Objectives: To evaluate the accuracy and interrater reliability of the ISTH definition of PE-related death in an autopsy cohort. Methods: We reviewed reports of 1064 consecutive adult autopsies that were performed at the NewYork-Presbyterian Hospital from January 2010 until July 2019. We included all patients with autopsy-confirmed PE-related death (cases) during that time frame, combined with patients who died in 2018 from a cause other than PE (controls). Based on clinical summaries, two adjudicators independently adjudicated the cause of death in each patient using the ISTH classification for the cause of death, blinded to the case/control status and ratio. The primary outcome was autopsy-confirmed PE-related death. We determined the sensitivity and specificity of the ISTH definition to identify autopsy-confirmed PE-related death, and its interrater reliability using the percentage agreement and Cohen's kappa. Results: A total of 126 patients who underwent autopsy were included in the analysis (median age, 68 years [range, 21–94], 60 [48%] women), of which 29 (23%) had died from PE as confirmed by autopsy. The ISTH definition's sensitivity and specificity for autopsy-confirmed PE-related death were 45% (95% CI, 26–64) and 99% (95% CI, 94–100), respectively. Interrater reliability for PE-related death was substantial (percentage agreement, 94% [95% CI, 89–97]; kappa, 0.73 [95% CI, 0.55–0.97]). Conclusion: Adjudication of the cause of death using the ISTH definition resulted in very high specificity, moderate sensitivity, and good interrater reliability for PE-related death.
AB - Background: The International Society on Thrombosis and Haemostasis (ISTH)’s Scientific and Standardization Committee (SSC) recently proposed a definition of pulmonary embolism (PE)-related death. Objectives: To evaluate the accuracy and interrater reliability of the ISTH definition of PE-related death in an autopsy cohort. Methods: We reviewed reports of 1064 consecutive adult autopsies that were performed at the NewYork-Presbyterian Hospital from January 2010 until July 2019. We included all patients with autopsy-confirmed PE-related death (cases) during that time frame, combined with patients who died in 2018 from a cause other than PE (controls). Based on clinical summaries, two adjudicators independently adjudicated the cause of death in each patient using the ISTH classification for the cause of death, blinded to the case/control status and ratio. The primary outcome was autopsy-confirmed PE-related death. We determined the sensitivity and specificity of the ISTH definition to identify autopsy-confirmed PE-related death, and its interrater reliability using the percentage agreement and Cohen's kappa. Results: A total of 126 patients who underwent autopsy were included in the analysis (median age, 68 years [range, 21–94], 60 [48%] women), of which 29 (23%) had died from PE as confirmed by autopsy. The ISTH definition's sensitivity and specificity for autopsy-confirmed PE-related death were 45% (95% CI, 26–64) and 99% (95% CI, 94–100), respectively. Interrater reliability for PE-related death was substantial (percentage agreement, 94% [95% CI, 89–97]; kappa, 0.73 [95% CI, 0.55–0.97]). Conclusion: Adjudication of the cause of death using the ISTH definition resulted in very high specificity, moderate sensitivity, and good interrater reliability for PE-related death.
KW - cause of death
KW - pulmonary embolism
KW - reproducibility of results
KW - validation study
KW - venous thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=85111800265&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/jth.15458
DO - https://doi.org/10.1111/jth.15458
M3 - Article
C2 - 34255928
SN - 1538-7933
VL - 19
SP - 2514
EP - 2521
JO - Journal of thrombosis and haemostasis
JF - Journal of thrombosis and haemostasis
IS - 10
ER -