1. Home>
2. Specialties>
3. Emergency Medicine>
4. Summary and Comment

Which Patients with Pulmonary Embolism Can Safely Be Discharged?

A simple clinical decision rule identifies patients with PE who can be treated at home.

After pulmonary embolism is diagnosed and the decision to initiate anticoagulation is made, the question of disposition arises. Which patients, if any, can safely be treated at home, and what criteria define them? Using data from 15,531 patients who were discharged from Pennsylvania hospitals after inpatient treatment for PE, these authors derived and validated a prediction rule. Patients were randomly selected to be in the derivation sample or the internal validation sample. The rule was validated externally using data from a cohort of 221 European inpatients with PE.

The authors found that patients who had none of the following 10 attributes were at low risk for death (30-day mortality, 1.5%):

• Age 70
  
• History of any of five comorbid conditions: cancer, heart failure, chronic lung disease, chronic renal disease, or cerebrovascular disease
  
• Pulse 110 beats per minute
  
• Systolic blood pressure <100 mm Hg
  
• Altered mental status
  
• Arterial oxygen saturation <90%
  

About 22% of patients in the three groups combined did not have any of the attributes and thus were classified as "low risk."

An editorialist notes that, using patient outcomes as the gold standard, these researchers had determined which patients with a final diagnosis of PE might safely be treated at home, and that use of such a rule could have a major effect on resource utilization.

Comment: Pending validation of this "rule" in a prospective study, it appears that almost a quarter of patients with PE can safely be treated at home. The effect of this change on resources would be very significant in this era of overcrowded emergency departments holding admitted patients for overcrowded hospitals.

— J. Stephen Bohan, MD, MS, FACP, FACEP

Published in Journal Watch Emergency Medicine March 28, 2006

Citation(s):

Aujesky D et al. A prediction rule to identify low-risk patients with pulmonary embolism. Arch Intern Med 2006 Jan 23; 166:169-75.

• Original article (Subscription may be required)
• Medline abstract (Free)

Moores LK. Diagnosis and management of pulmonary embolism: Are we moving toward an outcome standard? Arch Intern Med 2006 Jan 23; 166:147-8.

• Original article (Subscription may be required)
• Medline abstract (Free)