Disposition of emergency department patients with acute pulmonary embolism after ambulance arrival
Abstract Objective Most outpatients with pulmonary embolism (PE) are diagnosed in the emergency department (ED). The relationship between means of arrival, site of diagnosis, and disposition in ED patients with PE is unknown. We compared discharge home between patients arriving by emergency medical...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-12-01
|
| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.13068 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849304806233997312 |
|---|---|
| author | Samuel G. Rouleau Aidan R. Campbell Jie Huang Mary E. Reed David R. Vinson the KP CREST Network |
| author_facet | Samuel G. Rouleau Aidan R. Campbell Jie Huang Mary E. Reed David R. Vinson the KP CREST Network |
| author_sort | Samuel G. Rouleau |
| collection | DOAJ |
| description | Abstract Objective Most outpatients with pulmonary embolism (PE) are diagnosed in the emergency department (ED). The relationship between means of arrival, site of diagnosis, and disposition in ED patients with PE is unknown. We compared discharge home between patients arriving by emergency medical services (EMS) and those arriving by other means. Within the EMS cohort, we compared those with a recent PE diagnosis in the outpatient clinic setting to those who were diagnosed with PE in the ED. Methods This study was a secondary analysis of a retrospective cohort that included all adult, non‐pregnant ED patients treated for acute PE across 21 community EDs from January 2013 to April 2015. The primary outcome was discharge home within 24 h of ED registration; we also examined mortality. We described associations with patient arrival method and other patient characteristics. Results Among 2996 ED patient encounters with acute PE, 644 (21.5%) arrived by EMS. This group had a lower frequency of discharge (9.2% vs 26.4%) and higher 30‐day all‐cause mortality (8.7% vs 3.1%) than their counterparts (p < 0.001 for both). These associations remained after adjusting for confounding variables. Among the EMS cohort, 14 patients (2.2%) arrived with a PE diagnosis recently made in the outpatient setting. Conclusion Patients with PE who arrived at the ED by EMS were less likely to be discharged home within 24 h and more likely to die within 30 days than those who arrived by other means. Less than 3% of the EMS group had been diagnosed with PE before ED arrival. |
| format | Article |
| id | doaj-art-3c8d9815e1614bb7b2387b60a7f97cb2 |
| institution | Kabale University |
| issn | 2688-1152 |
| language | English |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-3c8d9815e1614bb7b2387b60a7f97cb22025-08-20T03:55:37ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522023-12-0146n/an/a10.1002/emp2.13068Disposition of emergency department patients with acute pulmonary embolism after ambulance arrivalSamuel G. Rouleau0Aidan R. Campbell1Jie Huang2Mary E. Reed3David R. Vinson4the KP CREST NetworkDepartment of Emergency Medicine UC Davis Health Sacramento California USANew York University New York New York USAKaiser Permanente Division of Research Oakland California USAKaiser Permanente Division of Research Oakland California USAKaiser Permanente Division of Research Oakland California USAAbstract Objective Most outpatients with pulmonary embolism (PE) are diagnosed in the emergency department (ED). The relationship between means of arrival, site of diagnosis, and disposition in ED patients with PE is unknown. We compared discharge home between patients arriving by emergency medical services (EMS) and those arriving by other means. Within the EMS cohort, we compared those with a recent PE diagnosis in the outpatient clinic setting to those who were diagnosed with PE in the ED. Methods This study was a secondary analysis of a retrospective cohort that included all adult, non‐pregnant ED patients treated for acute PE across 21 community EDs from January 2013 to April 2015. The primary outcome was discharge home within 24 h of ED registration; we also examined mortality. We described associations with patient arrival method and other patient characteristics. Results Among 2996 ED patient encounters with acute PE, 644 (21.5%) arrived by EMS. This group had a lower frequency of discharge (9.2% vs 26.4%) and higher 30‐day all‐cause mortality (8.7% vs 3.1%) than their counterparts (p < 0.001 for both). These associations remained after adjusting for confounding variables. Among the EMS cohort, 14 patients (2.2%) arrived with a PE diagnosis recently made in the outpatient setting. Conclusion Patients with PE who arrived at the ED by EMS were less likely to be discharged home within 24 h and more likely to die within 30 days than those who arrived by other means. Less than 3% of the EMS group had been diagnosed with PE before ED arrival.https://doi.org/10.1002/emp2.13068ambulance transporthospitalizationoutpatient managementpulmonary embolism |
| spellingShingle | Samuel G. Rouleau Aidan R. Campbell Jie Huang Mary E. Reed David R. Vinson the KP CREST Network Disposition of emergency department patients with acute pulmonary embolism after ambulance arrival Journal of the American College of Emergency Physicians Open ambulance transport hospitalization outpatient management pulmonary embolism |
| title | Disposition of emergency department patients with acute pulmonary embolism after ambulance arrival |
| title_full | Disposition of emergency department patients with acute pulmonary embolism after ambulance arrival |
| title_fullStr | Disposition of emergency department patients with acute pulmonary embolism after ambulance arrival |
| title_full_unstemmed | Disposition of emergency department patients with acute pulmonary embolism after ambulance arrival |
| title_short | Disposition of emergency department patients with acute pulmonary embolism after ambulance arrival |
| title_sort | disposition of emergency department patients with acute pulmonary embolism after ambulance arrival |
| topic | ambulance transport hospitalization outpatient management pulmonary embolism |
| url | https://doi.org/10.1002/emp2.13068 |
| work_keys_str_mv | AT samuelgrouleau dispositionofemergencydepartmentpatientswithacutepulmonaryembolismafterambulancearrival AT aidanrcampbell dispositionofemergencydepartmentpatientswithacutepulmonaryembolismafterambulancearrival AT jiehuang dispositionofemergencydepartmentpatientswithacutepulmonaryembolismafterambulancearrival AT maryereed dispositionofemergencydepartmentpatientswithacutepulmonaryembolismafterambulancearrival AT davidrvinson dispositionofemergencydepartmentpatientswithacutepulmonaryembolismafterambulancearrival AT thekpcrestnetwork dispositionofemergencydepartmentpatientswithacutepulmonaryembolismafterambulancearrival |