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• W3208020178 abstract "Of the ∼250,000 patients diagnosed with acute pulmonary embolism (PE) in US emergency departments each year, the vast majority are hospitalized, despite evidence from multiple studies and society-backed guidelines recommending consideration of discharge for the 25-50% with low-risk stratification scores. One of the potential barriers to outpatient management may be clinician concern about computed tomography (CT) PE findings perceived as high risk but not incorporated into risk stratification tools. There is an absence of literature on the ED management and outcomes of patients with low PESI scores and concerning CT PE findings. To evaluate the management and outcomes of patients with acute PE diagnosed in the ED, as stratified by PESI score and presence of concerning findings on CTPE imaging. PE cases at a tertiary academic center from 10/2016-12/2018 were identified by EMR query. Each case was manually abstracted twice by emergency physicians to confirm the diagnosis of acute PE made in the ED. Disagreements were adjudicated by third review. Clinical variables, including age, sex, ED vital signs, past medical history, and mental status were used to calculate the Pulmonary Embolism Severity Index (PESI) score. Outcomes included hospital length of stay, Pulmonary Embolism Response Team (PERT) activation, site of admission (ICU vs. non-ICU), and 7- and 30-day mortality. Patients were grouped based on PESI score and presence of one or more concerning” findings on CTPE: 1. Bilateral PE with saddle, main, or lobar arteries involved, 2. Evidence of right heart strain or 3. Presence of pulmonary infarct. 568 patients diagnosed with PE in the ED were divided into three risk groups: 1. Low PESI score (≤85) and no concerning CT findings (n = 117, 20.6%), 2. Low PESI score (≤85) and one or more concerning CT findings (n = 125 patients, 22%), 3. High PESI score (>85) (n = 326 patients, 57.4%). While few patients were discharged from the ED overall (n = 15, 2.6%), most were in Group 1 (n = 8, 6.8%) vs. Group 2 (n = 3, 2.4%) and Group 1 (n = 4, 1.2%), p = 0.005. Group 1 also differed significantly from Groups 2 and 3 in rate of cardiac POCUS (7.7 vs. 17.6 vs. 22.7%, p=0.002), formal echocardiography (27.4 vs 55.2 vs. 46%, p<0.001), and PERT activation (5.1 vs. 20.8 vs. 21.8%, p < 0.001). There was no difference between Group 1 and Group 2, however, in hospital length of stay (LOS 63.1 hrs vs. 55.3 hrs, p=0.61) or rate of ICU admission (2.6% vs. 0.8%, p=0.26), although both groups were significantly different than Group 3 (LOS 138.1 hrs and ICU 15.6%, p < 0.001). Likewise, there was no mortality at 7 days in Groups 1 or 2, vs. n = 25 patients (7.7%) in Group 3, p < 0.001. By 30 days, n = 2 patients (1.7%) had died from Group 1 vs. none in Group 2 vs. n = 60 (18.4%) in Group 3, p < 0.001. Patients with low risk PESI scores and concerning CTPE imaging findings had increased hospital resource utilization (lower discharge rate, more ultrasound imaging, increased PERT activation) compared to those without concerning imaging findings, without significant differences in hospital LOS or mortality at 7 and 30 days." @default.
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• W3208020178 date "2021-10-01" @default.
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• W3208020178 title "268 Impact of Concerning Computed Tomagraphy Imaging Findings on the Management and Outcomes of Acute Emergency Department Pulmonary Embolism With Low-Risk Stratification Scores" @default.
• W3208020178 doi "https://doi.org/10.1016/j.annemergmed.2021.09.281" @default.
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