Internal validation of a pulmonary thromboembolism risk index
Keywords:
Pulmonary thromboembolism; risk index; internal validationAbstract
Introduction: Pulmonary thromboembolism (PTE) is a serious, life-threatening disease with a worldwide distribution. Risk is estimated using indices or scales based on risk factors and vital signs.
Objective: To evaluate the validity of a pulmonary thromboembolism index based on risk factors.
Material and Methods: A technology development research study was conducted for the internal validation of a predictive index for PTE at the Carlos Manuel de Céspedes Hospital in Bayamo, Granma, Cuba, and the Millennium Heights Medical Complex in Castries, Saint Lucia, from January 1, 2025 to December 31, 2025. The index's internal validation, as well as its precision and accuracy, were determined.
Results: The overall precision of the index was 88.30%, and the positive likelihood ratio for the cutoff point of 10 was 14.33 (95% CI: 8.72 to 23.54). An Eta value of 0.734 demonstrates construct validity, while an area under the ROC curve of 0.924 indicates adequate discriminative capacity. Finally, the accuracy (0.914) and completeness (0.733) values of the index were demonstrated.
Conclusions: An index to predict the risk of developing pulmonary thromboembolism, based on a systematic review with meta-analysis, is presented. Internal validity, discriminative capacity, and accuracy were adequate.
Downloads
References
1. Khan F, Tritschler T, Kahn SR, Rodger MA. Venous thromboembolism. Lancet [Internet]. 2021;398(10294):64-77. Disponible en: https://doi.org/10.1016/S0140-6736(20)32658-1
2. Germini F, Zarabi S, Eventov M, Turcotte M, Li M, de Wit K. Pulmonary embolism prevalence among emergency department cohorts: A systematic review and metanalysis by country of study. J Thromb Haemost [Internet]. 2021;19(1):173-185. Disponible en: https://doi.org/10.1111/jth.15124
3. Cayuela L, Jara-Palomares L, Rondó P, Gaetaf AM, Cayuela A. Diferencias según sexo y edad de la tasa de mortalidad por tromboembolia pulmonar en España desde 1999 a 2021. Rev Esp Cardiol [Internet]. 2024;77(2):176-185. Disponible en: https://doi.org/10.1016/j.recesp.2023.08.010
4. Writing Creager MA, Barnes GD, Giri J, Mukherjee D, Jones WS, Burnett AE, et al. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation [Internet]. 2026 Mar 24;153(12):e977-e1051. Disponible en http://doi.org/10.1161/CIR.0000000000001415
5. Álvarez Aliaga A, Naranjo Flores L, González Aguilera JC. Factores de riesgo de tromboembolismo pulmonar, basado en una revisión sistemática con metaanálisis. Rev Cubana Med [Internet]. 2026;65. Disponible en: https://revmedicina.sld.cu/index.php/med/article/view/5116
6. Ortel TL, Neumann I, Ageno W, Beyth R, Clark NP, Cuker A, et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv [Internet]. 2020;4(19):4693-738. Disponible en: https://doi.org/10.1182/bloodadvances.2020001830
7. Yamashita Y, Morimoto T, Amano H, Takase T, Hiramori S, Kim K, et al. Validation of simplified PESI score for identification of low-risk patients with pulmonary embolism: From the COMMAND VTE Registry. Eur Heart J Acute Cardiovasc Care [Internet]. 2020;9(4):262-70. Disponible en: https://doi.org/10.1177/2048872618799993
8. Valdés Ramos ER, Álvarez Aliaga A, Valdés Bencosme ER. La circunferencia de cintura predice la cardiopatía isquémica en pacientes con diabetes mellitus tipo 2. Rev cubana med mil [Internet]. 2026 ;55(1):e026076964. Disponible en: https://revmedmilitar.sld.cu/index.php/mil/article/view/76964
9. Steyerberg EW. Clinical prediction models: a practical approach to development, validation, and updating [Internet]. New York: Springer; 2009. [Citado 29/03/2024]. Disponible en: https://doi.org/10.1111/j.17515823.2009.00085_22.x
10. World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Participants. JAMA [Internet]. 2025;333(1):71–74. Disponible en: http://doi.org/10.1001/jama.2024.21972
11. León-Román F, Pintado-Cort B, Barberà JA, Sellares J, Iturbe D, López-Zubizarreta M, et al. Diagnóstico y tratamiento de la tromboembolia de pulmón y de la hipertensión pulmonar en pacientes con enfermedad pulmonar intersticial difusa. Open Respir Arch [Internet]. 2025;7(1):100406. Disponible en: https://doi.org/10.1016/j.opresp.2025.100406
12. Yamashita Y, Morimoto T, Amano H, Takase T, Hiramori S, Kim K, et al. Validation of simplified PESI score for identification of low-risk patients with pulmonary embolism: From the COMMAND VTE Registry. Eur Heart J Acute Cardiovasc Care [Internet]. 2020;9(4):262-70. Disponible en: https://doi.org/10.1177/2048872618799993
13. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J [Internet]. 2020;41(4):543-603. Disponible en: https://doi.org/10.1093/eurheartj/ehz405
14. Barca-Hernando M, García-Ortega A, Martínez-Meñaca A, Ramírez-Martín MP, Rivas-Guerrero A, Tenes A. Tromboembolia de pulmón. Open Respir Arch [Internet]. 2024;6(4):100342. Disponible en: https://doi.org/10.1016/j.opresp.2024.100342
15. Cui YQ, Tan XM, Liu B, Zheng Y, Zhang LY, Chen ZA, et al. Analysis on risk factors of lung cancer complicated with pulmonary embolism. Clin Respir J [Internet]. 2021;15(1):6573. Disponible en: https://doi.org/10.1111/crj.13270
16. Heijboer RRO, Lubberts B, Guss D, Johnson AH, DiGiovanni CW. Incidence and Risk Factors Associated with Venous Thromboembolism After Orthopaedic Belowknee Surgery. J Am Acad Orthop Surg [Internet]. 2019;27(10):e482-e90. Disponible en: https://doi.org/10.5435/JAAOS-D-17-00787
17. Bucknor MD, Goo JS, Coppolino ML. The risk of potential thromboembolic, renal and cardiac complications of sickle cell trait. Hemoglobin [Internet]. 2014;38(1):28-32. Disponible en: https://doi.org/10.3109/03630269.2013.832689
18. Lin KH, Granka JM, Shastri AJ, Bonham VL, Naik RP. Ancestry-independent risk of venous thromboembolism in individuals with sickle cell trait vs factor V Leiden. Blood Adv [Internet]. 2024;8(21):5710-8. Disponible en: https://doi.org/10.1182/bloodadvances.2024014252
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Alexis Álvarez Aliaga, Liannys Lidia Naranjo Flores, Julio César González Aguilera, Alexis Suárez Quesada, Andrés José Quesada Vázquez, Eduardo René Valdés Ramos
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All the content of this magazine is in Open Access, distributed according to the terms of the Creative Commons Attribution-Noncommercial 4.0 License that allows non-commercial use, distribution and reproduction without restrictions in any medium, provided that the primary source is duly cited.
Download PDF
