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Original Research: Pulmonary Vascular Disease |

Analysis of National Trends in Admissions for Pulmonary Embolism

Sean B. Smith, MD; Jeffrey B. Geske, MD; Parul Kathuria, BA; Michael Cuttica, MD; Daniel R. Schimmel, MD; D. Mark Courtney, MD; Grant W. Waterer, MD; Richard G. Wunderink, MD
Author and Funding Information

FUNDING/SUPPORT: S. B. S. was supported by a National Institutes of Health/National Heart, Lung, and Blood Institute (Training Grant T32HL076139). R. G. W. is supported in part by the Centers for Disease Control and Prevention (Grant 1U18IP000490 “Incidence and Etiology of Influenza-Associated Community-Acquired Pneumonia in Hospitalized Persons Study”). G. W. W. is partially supported by the National Health and Medical Research Council of Australia.

aDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL

bDivision of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, MN

cDivision of Cardiovascular Disease, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL

dDepartment of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL

eUniversity of Western Australia, Perth, Australia

CORRESPONDENCE TO: Sean B. Smith, MD, Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, 660 N Westmoreland Rd, Lake Forest, IL 60045


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(1):35-45. doi:10.1016/j.chest.2016.02.638
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Background  Pulmonary embolism (PE) remains a significant cause of hospital admission and health-care costs. Estimates of PE incidence came from the 1990s, and data are limited to describe trends in hospital admissions for PE over the past decade.

Methods  We analyzed Nationwide Inpatient Sample data from 1993 to 2012 to identify patients admitted with PE. We included admissions with International Classification of Diseases, 9th revision, codes listing PE as the principal diagnosis as well as admissions with PE listed secondary to principal diagnoses of respiratory failure or DVT. Massive PE was defined by mechanical ventilation, vasopressors, or nonseptic shock. Outcomes included hospital lengths of stay, adjusted charges, and all-cause hospital mortality. Linear regression was used to analyze changes over time.

Results  Admissions for PE increased from 23 per 100,000 in 1993 to 65 per 100,000 in 2012 (P < .001). The percent of admissions meeting criteria for massive PE decreased (5.3% to 4.4%, P = .002), but the absolute number of admissions for massive PE increased (from 1.5 to 2.8 per 100,000, P < .001). Median length of stay decreased from 8 (interquartile range [IQR], 6-11) to 4 (IQR, 3-6) days (P < .001). Adjusted hospital charges increased from $16,475 (IQR, $10,748-$26,211) in 1993 to $25,728 (IQR, $15,505-$44,493) in 2012 (P < .001). All-cause hospital mortality decreased from 7.1% to 3.2% (P < .001), but population-adjusted deaths during admission for PE increased from 1.6 to 2.1 per 100,000 (P < .001).

Conclusions  Total admissions and hospital charges for PE have increased over the past two decades. However, the population-adjusted admission rate has increased disproportionately to the incidence of patients with severe PE. We hypothesize that these findings reflect a concerning national movement toward more admissions of less severe PE.

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