Two-thirds ED Visits for Low-Risk PE Admitted Unnecessarily

TOPLINE:

Emergency department (ED) discharge rates for patients with acute pulmonary embolism (PE) remained unchanged in the United States from 2012 to 2020, including those with low-risk and can be managed in outpatient settings.

METHODOLOGY:

• Recent data suggest that selected individuals with low-risk PE can be treated and monitored outside of a hospital setting.
• The study used a serial cross-sectional analysis by examining data from the National Hospital Ambulatory Medical Care Survey between 2012 and 2020.
• A total of 1,635,300 patients (mean age, 57.7 years) who visited the ED for acute PE were analyzed.
• The primary endpoint was the proportion of ED visits for acute PE that resulted in patient discharge directly from the ED.

TAKEAWAY:

• Overall, 30.7% of patients with acute PE were discharged from the ED over 9 years.
• Discharge rates, while remaining constant over time, were 38.2% between 2012 and 2014 and 33.4% between 2018 and 2020.
• No increase was noted in the ED discharges for acute PE over time (adjusted risk ratio, 1.01 per year; P =.85).
• The discharge rates were similar for patients who were at low risk according to the Pulmonary Embolism Severity Index (PESI; 35.9%), simplified PESI score (33.1%), or hemodynamic stability criteria (34.8%), and remained stable over the years.

IN PRACTICE:

“These findings suggest that outpatient management of acute PE remains underutilized despite clinical evidence and guideline recommendations,” the authors concluded.

SOURCE:

This study, led by Nathan W. Watson, Harvard Medical School, Boston, Massachusetts, was published on January 30, 2024, in Annals of Internal Medicine.

LIMITATIONS:

Misclassification may have been possible in this study. The cross-sectional study design limited the ability to examine recurrent venous thromboembolism, bleeding, and death. A complete patient medical history was unavailable, making evaluating multiple visits difficult.

DISCLOSURES:

One of the authors’ work was partly funded by a grant from the National Heart, Lung, and Blood Institute. Some authors reported financial relationships outside of this work.