Development of the THROMPE score for predicting centrally located pulmonary embolism: a retrospective cohort study

The primary aim of this study was to develop a clinical scoring system for predicting centrally located pulmonary embolism in patients with confirmed acute pulmonary embolism. The secondary objectives were to evaluate the association between the THROMPE score and 30-day mortality. This retrospective study included 531 adult patients who presented to the emergency department with suspected pulmonary embolism and underwent computed tomography pulmonary angiography. Independent predictors of centrally located pulmonary embolism were identified using multivariate logistic regression analysis to develop the THROMPE score. Receiver operating characteristic analysis was used to determine optimal cutoff values, assess the diagnostic performance of the THROMPE score and compare its performance with that of the Pulmonary Embolism Severity Index (PESI). Among the 365 patients diagnosed with PE, 47 (12.9%) had centrally located pulmonary embolism. The overall 30-day mortality rate was 13.7%, with approximately one-third of patients with centrally located pulmonary embolism dying within 30 days. Six independent predictors of central PE-confusion, respiratory rate ≥ 22/min, oxygen saturation ≤ 89%, pulmonary artery pressure ≥ 35 mmHg, D-dimer ≥ 4.4 µg/mL, and total protein ≥ 66.7 g/L-were incorporated into the THROMPE score. The THROMPE score (0-11 points) demonstrated excellent diagnostic performance for identifying centrally located pulmonary embolism at a cut-off value of ≥ 6 points (AUC 0.923). It significantly outperformed the PESI (AUC 0.763). The THROMPE score demonstrated high diagnostic accuracy for identifying centrally located pulmonary embolism, a subgroup associated with increased mortality risk. Its use may facilitate early identification and support timely risk assessment and clinical decision-making.