Key result
Intermediate-high risk PE is linked to ~50% higher ICU admission rates vs. intermediate-low risk.
Why the study?
Risk stratification and management of hemodynamically stable pulmonary embolism remain challenging, with limited knowledge about management of intermediate risk patients.
Does intermediate-high risk classification compared to intermediate-low risk classification predict higher hospital resource utilization in patients with intermediate risk pulmonary embolism?
Cohort (n=322)
Yes
Does intermediate-high risk classification compared to intermediate-low risk classification predict higher hospital resource utilization in patients with intermediate risk pulmonary embolism?
The 2019 ESC risk stratification criteria effectively identify intermediate-risk pulmonary embolism patients who require more intensive hospital resources, such as ICU admission and catheter-directed therapy.
May inform ICU triage decisions in intermediate-risk PE; leaves open whether ESC stratification improves outcomes in prospective studies.
BACKGROUND: Risk stratification and management of hemodynamically stable pulmonary embolism remains challenging. Professional societies have published stratification schemes, but little is known about the management of patients with intermediate risk pulmonary embolism. We describe the care of these patients at an academic health system. METHODS: Patient encounters from 1 January 2016 to 30 June 2017 were retrospectively identified utilizing a multihospital, electronic health record-based data warehouse. Using the 2019 European Society of Cardiology criteria, differences in hospital resource utilization, defined as intensive care unit admission, use of invasive therapies, and length of stay, were examined in patients with intermediate risk characteristics. RESULTS: A cohort of 322 intermediate risk patients, including 165 intermediate-low and 157 intermediate-high risk patients, was identified. Intermediate-high risk patients more often underwent catheter-directed therapy (14.0% vs. 1.8%; P<0.001) compared to intermediate-low risk patients and had a 50% higher rate of intensive care unit admission (relative risk 1.50; 95% confidence interval 1.06, 2.12; P=0.023). There was no difference in median intensive care unit length of stay (2.7 vs. 2.0 days; P=0.761) or hospital length of stay (5.0 vs. 5.0 days; P=0.775) between intermediate-high risk and intermediate-low risk patients. Patients that underwent invasive therapies had a 3.8-day shorter hospital length of stay (beta -3.75; 95% confidence interval -6.17, -1.32; P=0.002). CONCLUSION: This study presents insights into the hospital resource utilization of patients with intermediate risk pulmonary embolism. The 2019 European Society of Cardiology risk stratification criteria are a clinically relevant scheme that identifies patients more often treated with intensive care unit admission and advanced therapies.
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Sullivan et al. (2020) conducted a cohort in Intermediate risk pulmonary embolism (n=322). Intermediate-high risk pulmonary embolism vs. Intermediate-low risk pulmonary embolism was evaluated on Intensive care unit admission (RR 1.50, 95% CI 1.06, 2.12, p=0.023). Intermediate-high risk pulmonary embolism was associated with a higher rate of intensive care unit admission compared to intermediate-low risk patients (RR 1.50; 95% CI 1.06-2.12; P=0.023).
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