A retrospective analysis of outcomes in low- and intermediate–high-risk pulmonary embolism patients managed on an ambulatory medical unit in the UK. Issue 2 (8th April 2019)

• Record Type: Journal Article
• Authors: Reschen, Michael E.; Raby, Jonathan; Bowen, Jordan; Singh, Sudhir; Lasserson, Daniel; O'Callaghan, Christopher A.
• Is Part Of: ERJ open research. Volume 5:Issue 2(2019)
• Publication Date: 2019-04-08
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiration -- Periodicals; Respiration; Respiratory organs -- Diseases; Respiratory organs -- Diseases -- Treatment; Respiratory Tract Diseases; Electronic journals; Fulltext; Internet Resources; Periodicals; Periodical; 616.2005
• DOI: 10.1183/23120541.00184-2018
• Languages: English
• ISSNs: 2312-0541

Abstract

Pulmonary embolism (PE) is common and guidelines recommend outpatient care only for PE patients with low predicted mortality. Outcomes for patients with intermediate-to-high predicted mortality managed as outpatients are unknown. Electronic records were analysed for adults with PE managed on our ambulatory care unit over 2 years. Patients were stratified into low or intermediate-to-high mortality risk groups using the Pulmonary Embolism Severity Index (PESI). Primary outcomes were the proportion of patients ambulated, 30-day all-cause mortality, 30-day PE-specific mortality and 30-day re-admission rate. Of 199 PE patients, 74% were ambulated and at 30 days, all-cause mortality was 2% (four out of 199) and PE-specific mortality was 1% (two out of 199). Ambulated patients had lower PESI scores, better vital signs and lower troponin levels (morning attendance favoured ambulation). Over a third of ambulated patients had an intermediate-to-high risk PESI score but their all-cause mortality rate was low at 1.9% (one out of 52). In patients with intermediate-to-high risk, oxygen saturation was higher and pulse rate lower in those who were ambulated. Re-admission rate did not differ between ambulated and admitted patients. Two-thirds of patients with intermediate-to-high risk PE were ambulated and their mortality rate remained low. It is possible for selected patients with intermediate-to-high risk PESI scores to be safely ambulated. In a cohort of 199 patients with pulmonary embolism (PE), 52 were managed as outpatients despite an intermediate-to-high risk of mortality. Only 1 outpatient died within 30 days and not from PE, suggesting opportunities for increased ambulatory care. http://ow.ly/4p4D30oaNkr