Harvard Medical School, and Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (N.W.W.).
Harvard Medical School; Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center; and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (B.J.C., A.K., E.A.S.).
Ann Intern Med. 2024 Feb;177(2):134-143. doi: 10.7326/M23-2442. Epub 2024 Jan 30.
Outpatient management of select patients with low-risk acute pulmonary embolism (PE) has been proven to be safe and effective, yet recent evidence suggests that patients are still managed with hospitalization. Few studies have assessed contemporary real-world trends in discharge rates from U.S. emergency departments (EDs) for acute PE.
To evaluate whether the proportion of discharges from EDs for acute PE changed between 2012 and 2020 and which baseline characteristics are associated with ED discharge.
Serial cross-sectional analysis.
U.S. EDs participating in the National Hospital Ambulatory Medical Care Survey.
Patients with ED visits for acute PE between 2012 and 2020.
National trends in the proportion of discharges for acute PE and factors associated with ED discharge.
Between 2012 and 2020, there were approximately 1 635 300 visits for acute PE. Overall, ED discharge rates remained constant over time, with rates of 38.2% (95% CI, 17.9% to 64.0%) between 2012 and 2014 and 33.4% (CI, 21.0% to 49.0%) between 2018 and 2020 (adjusted risk ratio, 1.01 per year [CI, 0.89 to 1.14]). No baseline characteristics, including established risk stratification scores, were predictive of an increased likelihood of ED discharge; however, patients at teaching hospitals and those with private insurance were more likely to receive oral anticoagulation at discharge. Only 35.9% (CI, 23.9% to 50.0%) of patients who were considered low-risk according to their Pulmonary Embolism Severity Index (PESI) class, 33.1% (CI, 21.6% to 47.0%) according to simplified PESI score, and 34.8% (CI, 23.3% to 48.0%) according to hemodynamic stability were discharged from the ED setting.
Cross-sectional survey design and inability to adjudicate diagnoses.
In a representative nationwide sample, rates of discharge from the ED for acute PE appear to have remained constant between 2012 and 2020. Only one third of low-risk patients were discharged for outpatient management, and rates seem to have stabilized. Outpatient management of low-risk acute PE may still be largely underutilized in the United States.
None.
选择低危急性肺栓塞（PE）患者的门诊管理已被证明是安全有效的，但最近的证据表明，患者仍在住院治疗。很少有研究评估美国急诊部（ED）急性 PE 出院率的当代真实世界趋势。
评估 2012 年至 2020 年间 ED 治疗急性 PE 的出院比例是否发生变化，以及哪些基线特征与 ED 出院相关。
连续横断面分析。
参与国家医院门诊医疗调查的美国 ED。
2012 年至 2020 年间 ED 就诊的急性 PE 患者。
急性 PE 出院比例的全国趋势及与 ED 出院相关的因素。
2012 年至 2020 年间，约有 1635300 例急性 PE 就诊。总体而言，ED 出院率随时间保持稳定，2012 年至 2014 年期间为 38.2%（95%CI，17.9%至 64.0%），2018 年至 2020 年期间为 33.4%（CI，21.0%至 49.0%）（调整后的风险比为每年 1.01[CI，0.89 至 1.14]）。没有基线特征，包括已建立的风险分层评分，可预测 ED 出院的可能性增加；然而，教学医院的患者和拥有私人保险的患者更有可能在出院时接受口服抗凝治疗。只有 35.9%（CI，23.9%至 50.0%）的患者根据其肺栓塞严重程度指数（PESI）分类被认为是低危，33.1%（CI，21.6%至 47.0%）根据简化的 PESI 评分，34.8%（CI，23.3%至 48.0%）根据血流动力学稳定性被从 ED 环境中出院。
横断面调查设计和无法判定诊断。
在具有代表性的全国性样本中，2012 年至 2020 年间 ED 治疗急性 PE 的出院率似乎保持稳定。只有三分之一的低危患者接受门诊管理出院，而且这一比例似乎已经稳定。美国低危急性 PE 的门诊管理可能仍未得到充分利用。
无。
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