What is the clinical evidence from this study?

Study design: Observational. Population: Venous thromboembolism (DVT and PE) (n=1046000). Intervention: Venous thromboembolism. Primary outcome: Hospital admission.

September 29, 2016Open Access

Admission rates for emergency department patients with venous thromboembolism and estimation of the proportion of low risk pulmonary embolism patients: a US perspective

ASAdam J. SingerGeneral Cardiology HTHenry C. ThodeUniversity of North Carolina at Chapel Hill WPW. Frank PeacockHeart Failure & Transplant

Key Result

Hospital admission rates for emergency department patients with deep vein thrombosis and pulmonary embolism were 52% and 90%, respectively, with no significant changes between 2006 and 2010.

Study Design

Type

Observational (n=1,046,000)

Multicenter

Yes

Structured PICO

What are the hospital admission rates for emergency department patients with DVT and PE, and what proportion of PE patients are low-risk and potentially eligible for outpatient management?

Population

An estimated 1,046,000 adult emergency department visits for deep vein thrombosis or pulmonary embolism in the United States between 2006 and 2010, with a mean age of 59 years and 50% female.

Outcome

Hospital admission rates over time for patients presenting with DVT and PE

Despite guidelines encouraging outpatient management, admission rates for DVT and PE remain high in US emergency departments, even though up to half of PE patients are low-risk and potentially eligible for outpatient therapy.

Limitations

Retrospective analysis of a prospectively collected administrative data set
Calculation of sPESI scores may be inaccurate due to unreliable coding of comorbidities and missing data
Lack of information regarding patients' social support systems and bleeding risk
Agreement between ED physician and discharge diagnoses may have been limited
Only examined initial vital signs at the time of patient triage

Abstract

OBJECTIVE: Introduction of target specific anticoagulants and recent guidelines encourage outpatient management of low risk patients with venous thromboembolism. We describe hospital admission rates over time for patients presenting to US emergency departments (EDs) with deep vein thrombosis (DVT) and pulmonary embolism (PE) and estimate the proportion of low-risk PE patients who could potentially be managed as outpatients. METHODS: We performed a structured analysis of the National Hospital Ambulatory Medical Care Survey (a nationally representative weighted sampling of US ED visits) database for the years 2006-2010 including all adult patients with a primary diagnosis of DVT or PE. Simplified pulmonary embolus scoring index (sPESI) scores were determined in patients with PE to identify low risk patients. RESULTS: There were an estimated 652,000 and 394,000 ED visits for DVT and PE over the 5-year period (0.17%). Mean (SE) age was 59 (1.3), 50% were female, and 40% were > 65 years. Admission rates for DVT and PE were 52% and 90% respectively with no significant changes over time. In patients with DVT, predictors for admission were age (odds ratio, 1.03 per year of age 95% confidence interval, 1.01 to 1.05) and race (odds ratio, 4.1 95% confidence interval, 0.9 to 19.8 for Hispanics and 2.9 1.2 to 7.4 for Blacks). Of all ED patients with PE, 51% were low risk based on sPESI scores. CONCLUSION: Admission rates for DVT and PE have remained high and unchanged, especially with PE, minorities, and in older patients. Based on sPESI scores, up to half of PE patients might be eligible for early discharge or outpatient therapy.

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