PURPOSE: We sought to identify low risk acute pulmonary embolism (PE) patients by utilizing the Pulmonary Embolism Severity Index (PESI) who could be potentially discharged within 3 days after the initial diagnosis.
METHODS: This was a retrospective study of patients with acute PE who were admitted at our hospital from January 2005 through August 2010. Patients with PE were identified by computer listings of ICD-9 diagnosis codes (415.11, 415.19). PESI score was utilized for stratifying the acute PE patients into low, moderate and high risk categories. The length of hospital stay was noted in the low-risk PE patients. Early discharge was defined as ≤ 3 days of hospital stay.
RESULTS: Data was obtained in 321 patients with acute PE treated with anticoagulants. Of these patients 51.7% (166 of 321) were considered low risk according to the PESI score. Among those who were low risk, only 9% (15 of 166) patients were discharged ≤ 3 days and 91% (151 of 166) stayed > 3days. Eighty-four percent (127 of 151) who stayed >3 days had no other reasons than PE. Twenty four patients who stayed >3 days had causes other than PE, such as heart failure, acute coronary syndrome and pneumonia. Average length of stay of low, moderate and high risk patients was 7.33, 7.06 and 8.37 days respectively. The p-values determined for length of stay showed no significant or barely significant difference between the risk groups.
CONCLUSIONS: Half of the patients admitted in our community based teaching hospital with acute PE were low risk. Furthermore a substantial number i.e. 84% of the low risk patients were potential candidates for an early hospital discharge
CLINICAL IMPLICATIONS: PESI is based on 11 readily available clinical variables. It has been acknowledged in several studies as a useful risk stratification tool for identifying low risk acute PE patients. Identifying such a patient population for early hospital discharge would no doubt prove cost effective.
DISCLOSURE: The following authors have nothing to disclose: Ali Shafiq, Muhammad Janjua, Hamza Lodhi, Asim Mushtaq, Ahmed Alrifai, Abhijeet Basoor, Haroon Chughtai
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