Observation management of pulmonary embolism and agreement with claims-based and clinical risk stratification criteria in United States patients: a retrospective analysis. Issue 1 (December 2017)

• Record Type: Journal Article
• Authors: Nguyen, Elaine; Coleman, Craig; Peacock, W.; Wells, Philip; Weeda, Erin; Ashton, Veronica; Crivera, Concetta; Wildgoose, Peter; Schein, Jeff; Bunz, Thomas; Fermann, Gregory
• Is Part Of: BMC pulmonary medicine. Volume 17:Issue 1(2017)
• Page Start: 1
• Page End: 4
• Publication Date: 2017-12
• Subjects: Pulmonary embolism -- Observation stays -- Resource utilization -- Mortality; Lungs -- Diseases -- Periodicals; 616.24005
• DOI: 10.1186/s12890-017-0379-5
• Languages: English
• ISSNs: 1471-2466

Abstract

Abstract Background Guidelines suggest observation stays are appropriate for pulmonary embolism (PE) patients at low-risk for early mortality. We sought to assess agreement between United States (US) observation management of PE and claims-based and clinical risk stratification criteria. Methods Using US Premier data from 11/2012 to 3/2015, we identified adult observation stay patients with a primary diagnosis of PE, ≥1 PE diagnostic test claim and evidence of PE treatment. The proportion of patients at high-risk was assessed using the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) equation and high-risk characteristics (age > 80 years, heart failure, chronic lung disease, renal or liver disease, high-risk for bleeding, cancer or need for thrombolysis/embolectomy). Results We identified 1633 PE patients managed through an observation stay. Despite their observation status, IMPACT classified 46.4% as high-risk for early mortality and 33.3% had ≥1 high-risk characteristic. Co-morbid heart failure, renal or liver disease, high-risk for major bleeding, cancer and hemodynamic instability were low (each <4.5%), but 7.8% were >80 years-of-age and 19.4% had chronic lung disease. Conclusion Many PE patients selected for management in observation stay units appeared to have clinical characteristics suggestive of higher-risk for mortality based upon published claims-based and clinical risk stratification criteria.