Abstract 14494: National Trends in Emergency Department Discharges for Acute Pulmonary Embolism, 2006-2015

Abstract

Introduction: Outpatient management for selected low-risk patients with acute pulmonary embolism (PE) has emerged as a safe and feasible approach that is currently supported by clinical practice guidelines. However, recent evidence suggests that many patients are still managed with hospital admission. Few studies have assessed recent real-world, national trends in discharge rates for acute PE from the emergency department (ED). Methods: We conducted an observational study leveraging data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) between the years 2006-2020. NHAMCS is a nationally representative probability sample which reflects ED visits within the US. All patients with a primary diagnosis of acute PE were included. Subgroup analysis was performed on patients who were hemodynamically stable (heart rate<110 and systolic blood pressure>100) and those with a PESI risk class I or II. Results: Between 2006-2020, there were an estimated 2,519,606 ED visits for acute PE. Among the whole cohort, the mean age was 58.2 (SE: 1.53) and 59.1% were female. Overall, 22.1% of patients with acute PE were discharged from the ED, which increased from 7.8% between 2006-2008 to 32.1% between 2018-2020. A total of 67.9% of patients were hospitalized, which decreased from 83.7% between 2006-2008 to 61.9% between 2018-2020. When stratified by hemodynamic stability or low PESI risk class, similar trends were observed (Figure). Since 2012, 33.0% of patients with PESI class I or II were discharged and 57.8% were hospitalized. Conclusion: In a representative nationwide sample, rates of discharge from the ED for acute PE have increased over the past fifteen years with the largest increase occurring between 2009-2014. However, since 2012, only one-third of low-risk patients presenting to the ED were discharged for outpatient management and rates appear to have stabilized. We speculate that outpatient management for low-risk acute PE is still underutilized in the US.