Ambulatory investigation and treatment of patients with suspected pulmonary embolism: a retrospective review of one year’s experience

The objective of this study was to establish the feasibility and safety of managing suspected and proven PE without overnight in-patient stay and was designed as a retrospective review of experience. The study took place at the AMU, Southampton General Hospital, Southampton, England. The participants were consecutive patients between October 2002 and 2003 with clinical features suggesting PE, requiring diagnostic imaging, and who fulfilled pre-defined community management criteria. The main outcome measures were anticoagulation complications, 30-day re-admission, PE within six months, and death any time following presentation. The results were as follows: 133 patients were identified, 22 of whom were treated in the community for PE without significant complications. Eight 30-day re-admissions were all in the ‘PE excluded’ group. One re-admission may have related to anticoagulant therapy. Five patients (4%) died during follow up. No deaths could be attributed to premature discharge or management in the community. The study concluded that selected patients with suspected and proven PE may be managed in the community within a carefully defined protocol, although larger studies are required to confirm the safety of this approach.