Clin Exp Emerg Med.  2016 Sep;3(3):126-131. 10.15441/ceem.15.096.

Admission rates for emergency department patients with venous thromboembolism and estimation of the proportion of low risk pulmonary embolism patients: a US perspective

• Singer AJ
• Thode HC
• Peacock WF

• KMID: 2361018
• DOI: http://doi.org/10.15441/ceem.15.096

Abstract

OBJECTIVE
Introduction of target specific anticoagulants and recent guidelines encourage outpatient management of low risk patients with venous thromboembolism. We describe hospital admission rates over time for patients presenting to US emergency departments (EDs) with deep vein thrombosis (DVT) and pulmonary embolism (PE) and estimate the proportion of low-risk PE patients who could potentially be managed as outpatients.
METHODS
We performed a structured analysis of the National Hospital Ambulatory Medical Care Survey (a nationally representative weighted sampling of US ED visits) database for the years 2006-2010 including all adult patients with a primary diagnosis of DVT or PE. Simplified pulmonary embolus scoring index (sPESI) scores were determined in patients with PE to identify low risk patients.
RESULTS
There were an estimated 652,000 and 394,000 ED visits for DVT and PE over the 5-year period (0.17%). Mean (SE) age was 59 (1.3), 50% were female, and 40% were > 65 years. Admission rates for DVT and PE were 52% and 90% respectively with no significant changes over time. In patients with DVT, predictors for admission were age (odds ratio, 1.03 per year of age [95% confidence interval, 1.01 to 1.05]) and race (odds ratio, 4.1 [95% confidence interval, 0.9 to 19.8] for Hispanics and 2.9 [1.2 to 7.4] for Blacks). Of all ED patients with PE, 51% were low risk based on sPESI scores.
CONCLUSION
Admission rates for DVT and PE have remained high and unchanged, especially with PE, minorities, and in older patients. Based on sPESI scores, up to half of PE patients might be eligible for early discharge or outpatient therapy.

Keyword

Pulmonary embolism; Low-risk; Simplified pulmonary embolus scoring index score; Outpatients; Emergency service, hospital

MeSH Terms

Adult
Anticoagulants
Continental Population Groups
Diagnosis
Embolism
Emergencies*
Emergency Service, Hospital*
Female
Hispanic Americans
Humans
Outpatients
Pulmonary Embolism*
Venous Thromboembolism*
Venous Thrombosis
Anticoagulants