SESSION TITLE: Pulmonary Embolism
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 29, 2013 at 04:30 PM - 05:30 PM
PURPOSE: There have been a number of studies describing the characteristics and outcomes of patients with acute pulmonary embolism (PE). However, most of these studies have either focused on patients who develop PE in the outpatient setting or not distinguished outpatient from inpatient setting. Patients who develop PE in an inpatient setting may be at higher risk of bleeding and/or death.
METHODS: We performed a retrospective chart review of all hospitalized patients who were diagnosed with PE between January 2007 and December 2011. We identified patients who developed PE in an inpatient setting (group A) and compared them to patients who developed it in an outpatient setting (group B). We compared the demographics, risk factors for venous thromboembolism (VTE), clinical presentation, hemodynamic profile and outcomes between the two groups.
RESULTS: The demographics were similar between the two groups. Previous history of VTE was more common in group B (3 (3.66%) vs. 16 (16.84%), p = 0.0062) but other risk factors for VTE were more common in group A: smoking (33 (40.24%) vs. 25 (26.32%), p = 0.0245), lower limb paralysis (9 (10.98%) vs. 2 (2.11%),p = 0.0250), immobilization for more than three days (54 (65.85%) vs. 18 (18.95%), p < 0.0001), and central venous catheterization (30 (37.04%) vs. 5 (5.26%), p < 0.0001). Platelet count was higher in group A (297.90 ± 146.78 vs. 241.11 ± 82.41, p = 0.0306). Complaints of shortness of breath (SOB) and chest pain (CP) were more common in group B (SOB: 28 (34.15%) vs. 70 (73.68%), p < 0.0001; CP: 12 (14.63%) vs. 48 (50.53%), p < 0.0001) but oxygen saturation was lower in group A (95.48% ± 4.52% vs. 97.09% ± 2.53%, p = 0.0210). Hospital length of stay (LOS) following the diagnosis of PE was longer in group A (17.78 ± 22.45 days vs. 6.54 ± 4.24 days, p < 0.0001). The outcome of major bleeding or death was more common in group A (18 (21.96%) vs. 9 (9.47%), p = 0.0346; odds ratio: 2.68; 95% CI 1.13-6.37).
CONCLUSIONS: Patients who develop PE in an inpatient setting differ from those who develop it in an outpatient setting. They are symptomatic less often yet have risk factors for VTE more often. PE in such patients is associated with a longer hospital LOS and a significantly higher risk of major bleeding or death.
CLINICAL IMPLICATIONS: Further understanding of patient population difference in development of VTE. May lead to seperate predictive scores for inpatients suspected to have PE.
DISCLOSURE: The following authors have nothing to disclose: Ankur Girdhar, Amita Singh, Abubakr Bajwa, James Cury, Lisa Jones, Faisal Usman, Adil Shujaat
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