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Abstract

Introduction: High mortality associated with pulmonary embolism (PE) leads to increased concern when evaluating patients complaining of chest pain or shortness of breath in the emergency department (ED). Computed tomography pulmonary angiography (CTPA) is the test of choice for PE and is frequently employed in the ED. Our study aimed to determine how often CTPA is positive for PE, and the ultimate disposition and discharge diagnosis for patients evaluated for PE. Hypothesis: Though patients diagnosed with PE commonly need higher levels of care (intermediate care unit or intensive care unit), there is a low overall diagnostic yield for PE using CTPA, and a majority of patients are admitted with non-specific findings. Methods: We performed a retrospective cohort study of consecutive ED patients (January-June 2010) evaluated for PE in the ED using CTPA. Charts were reviewed to gather the presenting complaint, ED disposition (home vs. floor vs. higher level of care), and length of stay (LOS) for patients admitted to the hospital. For patients admitted despite a negative CTPA, we obtained final discharge diagnoses based on ICD-9 codes and physician dictations. Results: The cohort included 776 subjects (mean age 50 + 16.5 years; female 71.6%). CTPA was positive for PE in 6.6%. Of patients diagnosed with PE, 94.1% were admitted; 20.9% to a higher level of care, and 5.9% diagnosed with a PE died. All deaths occurred either in the ED or the intensive care unit (ICU); 20% of patients with PE admitted to the ICU died. The majority of patients with PE (79.1%) were admitted to the floor with average LOS 5.4 days. Despite a negative CTPA, 304 patients were admitted to the hospital; 5.3% to a higher level of care and 1.6% died. The most common admission diagnosis was non-specific chest pain (44.7%) and of these 68.4% were discharged with a similar diagnosis of “chest pain NOS”. Average LOS for patients admitted with chest pain was 1.9 days. Conclusions: The diagnostic yield of CTPA used in the ED for PE is low. Patients diagnosed with PE often need higher levels of care and have higher mortality, but the majority of patients without PE are admitted and discharged with non-specific findings after negative CTPA.