P265 RED ZONE: 22 MILES OF FIRE. ANALYSIS OF THE TIMING AND PROCESSES OF ELDERLY PATIENTS WITH ACUTE PULMONARY EMBOLISM IN THE EMERGENCY ROOM. THE REAL–LIFE EXPERIENCE OF 5 YEARS IN THE EMERGENCY ROOM. (18th May 2022)

• Record Type: Journal Article
• Authors: Savioli, G; Ceresa, I; Mugellini, A; Martignoni, A; Muzzi, A; Novara, E; Fumoso, F; Lapia, F; Brattoli, M; Bressan, M
• Is Part Of: European heart journal supplements. Volume 24(2022)Supplement C
• Publication Date: 2022-05-18
• Subjects: Cardiology -- Periodicals; Cardiology -- Europe -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/suac012.256
• Languages: English
• ISSNs: 1520-765X

Abstract

Abstract: Purpose: to describe the role of the emergency room in the diagnostic–therapeutic process of acute pulmonary embolism. Methods: single–center retrospective observational study, on all geriatric patients (> 75 years) who entered our ED, where they were diagnosed with acute PE. Enrollment began in 2016 and ended in 2019. We analyzed means of presentation, priority codes for medical examination, exit code, hospitalization needs. We collected data from medical history, physical examination, laboratory tests, imaging, outcomes. Results: We enrolled 247 patients, all requiring hospitalization for acute pulmonary embolism. The average age of 83 with female prevalence (63%). Median wait times for medical examination were 42 minutes. The average waiting times, however, for the large number of low priority codes (40% between 5 and 4 codes), was more than 6 hours. All patients required a chest CT with contrast, 44% first did a chest x–ray and 2% an ultrasound. All patients underwent ECG and blood tests. The time spent in the Emergency Department (LOS) was on average 18 hours. 58% of patients were managed in areas of low or medium intensity, 42% were sent to OBI for therapeutic diagnostic completion or necessary monitoring. OBI patients were on average 504 minutes. 56% face the phenomenon of boarding. 34% showed massive EP, 32% showed organ damage. 41% were considered to be at high risk of short–term mortality according to European guidelines, 8% required intensive care and in–hospital mortality was 7.7%. Under triage is 31%. Conclusions: The population that arrives in ED due to pulmonary embolism presents an overall clinical picture with a high degree and high care and therapeutic complexity. Need for numerous investigations and second level imaging. They often require complex therapies and multi–parameter monitoring during stabilization and observation. Therefore, the time spent in the emergency room is long. The workload to treat these patients is high and requires excellent multi–professional and multidisciplinary integration, especially between the various professional figures in urgency, the laboratory and radiology.