Pulmonary Vascular Disease |

Clinical Timecourse in Acute Massive Pulmonary Embolism Does Not Predict Mortality FREE TO VIEW

Jennifer Palminteri; Katie Stokem; Joel Wirth
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Maine Medical Center, Portland, ME

Chest. 2014;146(4_MeetingAbstracts):832A. doi:10.1378/chest.1994911
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SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Risk stratification in pulmonary embolism is essential to determine which patients require escalation of care. We measured the clinical timecourse for patients who presented with Acute Massive Pulmonary Embolism (AMPE) in order to better understand the available time to perform risk stratification.

METHODS: We retrospectively reviewed all cases of PE at our institution between January 2011 and June 2012 to identify patients with AMPE. Demographic information was collected from the electronic medical record and each patient's clinical course was reviewed. The specific times for clinical events were recorded including the date/time of EMS call, ER arrival, diagnostic studies, onset of shock, cardiac arrest, thrombolysis, and time of death. Statistical difference were considered significantly different for p-values less than 0.05.

RESULTS: During the study period 287 patients were diagnosed with acute PE and 41 patients (14%) were classified as AMPE. Among the AMPE patients the mean age was 61 years, 59% were female. The incidence of cardiac arrest was 44% and the overall mortality was 42%. There were 23 patients with AMPE admitted through the emergency department. There was no significant difference between survivors and non-survivors in the median times from EMS call to ER arrival, time from ER arrival to diagnostic test, time from diagnostic test to thrombolysis, or time from AMPE diagnosis to thrombolysis (all p > .05.) The median time from EMS call to death in the AMPE non-survivors was 23.8 hours, from ER arrival to death was 23.2 hours and the time from confirmatory diagnostic test to death was 21.3 hours.

CONCLUSIONS: Mortality from AMPE is high. We found no statistically significant differences in the times to PE specific events during hospitalization leading up to the time of death. There appears to be limited but sufficient time to perform risk stratification in the majority of the highest risk patients.

CLINICAL IMPLICATIONS: Clinicians should be cognizant of the clinical timecourse for patients with high risk pulmonary embolism and the limited window of opportunity to perform risk stratification.

DISCLOSURE: The following authors have nothing to disclose: Jennifer Palminteri, Katie Stokem, Joel Wirth

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