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• W2069537285 abstract "Pulmonary embolism (PE) and deep venous thrombosis (DVT) are common diagnoses in the emergency department (ED). Outpatient treatment has been shown to be safe and effective in selected patients after ED visits. It is not known how frequently ED patients with DVT or PE are treated as outpatients or which patient characteristics predict outpatient management. Describe the national prevalence of outpatient treatment of PE and DVT in U.S. EDs, and examine the patient-level predictors of outpatient treatment. We examined adult ED visits for PE and DVT using discharge data from the Nationwide Emergency Department Sample (NEDS) from 2006-2010, a nationally representative dataset containing ED visits for both admitted and treat-and-release patients. Presence of PE or DVT was identified by primary ICD-9 discharge diagnosis code. Location of treatment (inpatient/outpatient) was determined by the ED disposition variable with admitted or transferred to another short-term hospital classified as inpatient treatment regardless of length of stay; patients who left prior to treatment or died in the ED were excluded. Enhanced Charlson score was calculated based on secondary diagnoses. Hierarchical logistic regression was used to account for the clustering of patients within hospitals when examining multivariate predictors of outpatient treatment. We report proportions and odds ratios (ORs). From 2006-2010, NEDS included an average of 142,000 PE and 169,000 DVT visits annually, with 5.0% (95% CI 4.7, 5.3%) and 42.4% (41.3, 43.4%) treated as outpatients, respectively. There was a small increase in outpatient treatment of PE from 5.0% in 2006 to 6.0% in 2010 (p<0.001), and no change over time in the rate of outpatient treatment for DVT (p=0.24). Patients characteristics, prevalence of outpatient treatment, and the adjusted ORs of outpatient treatment are shown in the Table. Outpatient treatment of PE and DVT is associated with sex, younger age, lower comorbidity (Charlson score), private insurance or self-pay, lower income and non-metropolitan residence. Among patients with an enhanced Charlson score of zero, 8.0% (7.8, 8.2%) of PE patients and 54.8% (54.5, 55.1%) of DVT patients were treated as outpatients. Despite evidence that outpatient treatment of DVT and PE is safe and cost-effective in appropriately selected patients, a small number of patients with PE and a minority of patients with DVT are treated as outpatients, with little change since 2006. There appears to be room to improve the efficiency of care delivery for patients with PE and DVT and no comorbidities as the majority are still treated in inpatient settings.TableCharacteristics of VTE patients and odds of outpatient treatment by patient characteristicsDVT patientsDVTOR (95% CI)PE patientsPEOR (95% CI)Primary payorMedicare46.2%Reference49.8%ReferenceMedicaid10.3%1.13 (1.07, 1.18)8.7%1.34 (1.20, 1.49)Private insurance31.4%1.38 (1.34, 1.43)33.2%1.12 (1.03, 1.21)Self-pay/No charge8.4%1.44 (1.37, 1.51)5.4%1.41 (1.25, 1.58)Patient locationLarge central/fringe metro51.4%Reference49.7%ReferenceMedium/small metro30.6%1.29 (1.23, 1.36)32.9%1.23 (1.12, 1.35)Micropolitan/Noncore18.0%1.32 (1.24, 1.39)17.4%1.64 (1.47, 1.82)Sex (Male reference)Female, not pregnant52.7%1.19 (1.16, 1.22)54.5%1.12 (1.06, 1.18)Female, pregnant0.6%0.14 (0.12, 0.16)0.1%0.78 (0.38, 1.59)Additional significant variables: decreasing age, income, enhanced Charlson score. Open table in a new tab" @default.
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• W2069537285 date "2013-10-01" @default.
• W2069537285 modified "2023-10-16" @default.
• W2069537285 title "Prevalence and Patient Predictors in Outpatient Treatment of Venous Thromboembolic Disease" @default.
• W2069537285 doi "https://doi.org/10.1016/j.annemergmed.2013.07.379" @default.
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