Key result
The most frequent reason for hospital admission of acute pulmonary embolism patients based on the Hestia criteria was the need for oxygen therapy, while 38% were admitted solely based on the subjective criterion.
Why the study?
It was unknown how often and why the subjective Hestia criterion medical/social reason for admission was scored when selecting acute PE patients for outpatient treatment.
What are the reasons for hospitalization of patients with acute pulmonary embolism based on the Hestia decision rule?
Observational (n=1,166)
Yes
What are the reasons for hospitalization of patients with acute pulmonary embolism based on the Hestia decision rule?
The subjective Hestia criterion for PE hospitalization is most often used for oxygen therapy or due to the severity of RV overload and hemodynamic response.
Answers are grounded in this paper and cite their sources.
May guide oxygen-focused triage in acute PE; leaves open prospective validation of subjective Hestia criterion.
BACKGROUND: The Hestia criteria can be used to select pulmonary embolism (PE) patients for outpatient treatment. The subjective Hestia criterion "medical/social reason for admission" allows the treating physician to consider any patient-specific circumstances in the final management decision. It is unknown how often and why this criterion is scored. METHODS: This is a patient-level post hoc analysis of the combined Hestia and Vesta studies. The main outcomes were the frequency of all scored Hestia items in hospitalized patients and the explicit reason for scoring the subjective criterion. Hemodynamic parameters and computed tomography-assessed right ventricular (RV)/left ventricular (LV) ratio of those only awarded with the subjective criterion were compared with patients treated at home. RESULTS: From the 1,166 patients screened, data were available for all 600 who were hospitalized. Most were hospitalized to receive oxygen therapy (45%); 227 (38%) were only awarded with the subjective criterion, of whom 51 because of "intermediate to intermediate-high risk PE." Compared with patients with intermediate risk PE (RV/LV ratio > 1.0) treated at home (179/566, 32%), hospitalized patients with only the subjective criterion had a higher mean RV/LV ratio (mean difference +0.30, 95% confidence interval [CI] 0.19-0.41) and a higher heart rate (+18/min, 95% CI 10-25). No relevant differences were observed for other hemodynamic parameters. CONCLUSION: The most frequent reason for hospital admission was oxygen therapy. In the decision to award the subjective criterion as sole argument for admission, the severity of the RV overload and resulting hemodynamic response of the patient was taken into account rather than just abnormal RV/LV ratio.
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Hendriks et al. (2020) conducted an observational in Acute Pulmonary Embolism (n=1,166). Hestia decision rule vs. Outpatient treatment was evaluated on Frequency of need for oxygen supply as reason for hospitalization. The most frequent reason for hospital admission of acute pulmonary embolism patients based on the Hestia criteria was the need for oxygen therapy, while 38% were admitted solely based on the subjective criterion.
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