Stewart Matthew, Bledsoe Joseph, Madsen Troy, Sturges Zachary, McGuire Trever, Rayner Thomas, Hamilton David, Barton Erik
From the *University of Utah, Salt Lake City, UT; and †Intermountain Medical Center, Salt Lake City, UT.
Crit Pathw Cardiol. 2015 Sep;14(3):87-9. doi: 10.1097/HPC.0000000000000046.
Pulmonary embolism (PE) is a common disease in emergency medicine and treatment approaches vary greatly. Emergency department observation units (EDOUs) have provided the opportunity to complete a PE workup, initiate treatment, and arrange appropriate follow-up for low-risk patients.
We sought to evaluate the utilization and safety of a treatment protocol for low-risk PE in an EDOU.
A prospective evaluation was performed in our EDOU for the treatment of low-risk PE between December 1, 2010 and May 31, 2012. The PE treatment protocol included telemetry monitoring, initiation of anticoagulation, performance of an echocardiogram, bilateral lower extremity duplex ultrasound, and consultation by the hospital's thrombosis service to arrange outpatient follow-up. The primary outcome measure was inpatient admission and any complications during the EDOU stay or during a 30-day follow-up period.
Twelve patients were assigned to the EDOU for the PE treatment protocol during the 18-month study period. Six patients (50%) were admitted to an inpatient unit following the EDOU stay. Reasons for inpatient admission included hypoxia/worsening dyspnea (2), right ventricular strain on echocardiogram (1), large clot burden on duplex ultrasound (1), and lack of availability of testing/thrombosis service consultation during the EDOU stay (2). There were no adverse events in the EDOU. All patients reported compliance with outpatient follow-up, and none of the patients reported hospitalization or adverse events during the 30-day follow-up period. Utilization of the PE treatment protocol in our EDOU was surprisingly low (<1 patient/month), possibly because of provider awareness of the protocol.
Although the overall inpatient admission rate from the EDOU was high, some of these cases related to logistical issues rather than medical concerns or complications. Further evaluation of an EDOU PE protocol may continue to demonstrate the safety and efficiency of this approach when compared with inpatient admission.
肺栓塞（PE）是急诊医学中的常见疾病，治疗方法差异很大。急诊科观察单元（EDOU）为低风险患者完成肺栓塞检查、开始治疗并安排适当的随访提供了机会。
我们试图评估EDOU中低风险肺栓塞治疗方案的使用情况及安全性。
2010年12月1日至2012年5月31日期间，我们在EDOU对低风险肺栓塞治疗进行了前瞻性评估。肺栓塞治疗方案包括遥测监测、启动抗凝治疗、进行超声心动图检查、双侧下肢双功超声检查，以及由医院血栓服务部门会诊以安排门诊随访。主要结局指标是住院情况以及在EDOU住院期间或30天随访期内的任何并发症。
在18个月的研究期间，有12名患者被分配到EDOU接受肺栓塞治疗方案。6名患者（50%）在EDOU住院后被收入住院病房。住院原因包括低氧/呼吸困难加重（2例）、超声心动图显示右心室劳损（1例）、双功超声显示血栓负荷大（1例），以及在EDOU住院期间无法进行检查/血栓服务会诊（2例）。EDOU内未发生不良事件。所有患者均报告遵守门诊随访，且在30天随访期内无患者报告住院或不良事件。我们EDOU中肺栓塞治疗方案的使用率低得出奇（<1例/月），可能是因为医务人员对该方案的认知度问题。
虽然EDOU的总体住院率较高，但其中一些病例与后勤问题有关，而非医疗问题或并发症。与住院治疗相比，对EDOU肺栓塞方案的进一步评估可能会继续证明这种方法的安全性和有效性。
