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EPIPHANY Index for pulmonary embolism in cancer
Risk of serious complications in cancer-associated PE.
EPIPHANY Index for pulmonary embolism in cancer
Any Hestia-like clinical decision rule criterion present?
SBP <100 mmHg, SpO2 <90%, respiratory rate >=30/min, pulse >=110 bpm, sudden/progressive dyspnoea, or clinically relevant bleeding / high bleeding risk / platelets <50,000.
ECOG performance status >=2?
PE-specific symptoms present?
e.g. sudden or progressive dyspnoea, pleuritic chest pain, syncope, or haemoptysis attributable to the PE.
Tumour status
ResultIntermediate risk
15-day risk of serious complications about 9.4 % (serious complications include major bleeding, ICU admission, CPR, mechanical ventilation, fibrinolysis, or death).
- 15-day serious complications
- 9.4 %
When to use
- Stratifying complication risk in cancer patients with suspected or incidental pulmonary embolism to guide outpatient versus inpatient management.
Formula
Decision tree: with no clinical-decision-rule criterion, low risk if the tumour is controlled/resected, otherwise intermediate. With any criterion present, intermediate if ECOG <2 and no PE-specific symptoms, otherwise high risk.
Pearls and pitfalls
- Derived and validated in both suspected and incidental cancer-associated PE.
- This is a simplified reconstruction of the published CART decision tree; use alongside clinical judgement.