Abstract 11434: Emergency Department Disposition for Patients with Low-Risk Acute Pulmonary Embolism: A Nationwide Analysis

Abstract

Background: Outpatient management has been shown to be safe and effective for patients presenting to the emergency department (ED) with low-risk acute pulmonary embolism (PE). The degree to which outpatient management for PE has evolved in contemporary clinical practice is uncertain, as is an understanding of whether certain patient or hospital factors are associated with outpatient PE management. Methods: Using the Nationwide Emergency Department Sample, we identified hospitalizations with primary or secondary PE between 2006-2018. We excluded patients who were <18 years old, died during ED visit, received systemic or catheter-directed thrombolysis, or had any of the following: acute coronary syndrome, heart failure, atrial fibrillation, chronic kidney/lung disease, gastrointestinal bleeding, or respiratory failure. Multivariable regression models were utilized to identify patient and hospital factors that predicted discharge to home from the ED. Results: Among 516,670 ED visits with acute PE, 92,108 (17.8%) patients were discharged to home. As compared to those admitted, patients who were managed as an outpatient were younger (median 52, interquartile range (IQR) 26-78 vs 61 IQR (35-87) years, P<0.001), and more female (57.9% vs 53.1%, P<0.001). In more recent years there was a significant increase in discharge from ED to home (9.2% in 2016 to 29.7% in 2018 (relative increase 69.0%, P<0.001)) Panel A. In a sensitivity analysis, when PE was only a primary diagnosis, the rate of home disposition increased from 4.8% to 27.7%, P<0.001. Patient and hospital factors associated with an increased likelihood of home discharge are listed Panel B . Conclusion: Outpatient management of patients with low-risk PE has become increasingly common, with more than one-quarter of patients evaluated in the ED now discharged to home. Patient demographics, seasonal variation, and hospital characteristics were associated with a differential effect on the home disposition.