Disposition of emergency department patients with acute pulmonary embolism after ambulance arrival.

Abstract

Most outpatients with pulmonary embolism (PE) are diagnosed in the emergency department (ED). The relationship between means of arrival, site of diagnosis, and disposition in ED patients with PE is unknown. We compared discharge home between patients arriving by emergency medical services (EMS) and those arriving by other means. Within the EMS cohort, we compared those with a recent PE diagnosis in the outpatient clinic setting to those who were diagnosed with PE in the ED. This study was a secondary analysis of a retrospective cohort that included all adult, non-pregnant ED patients treated for acute PE across 21 community EDs from January 2013 to April 2015. The primary outcome was discharge home within 24h of ED registration; we also examined mortality. We described associations with patient arrival method and other patient characteristics. Among 2996 ED patient encounters with acute PE, 644 (21.5%) arrived by EMS. This group had a lower frequency of discharge (9.2% vs 26.4%) and higher 30-day all-cause mortality (8.7% vs 3.1%) than their counterparts (p<0.001 for both). These associations remained after adjusting for confounding variables. Among the EMS cohort, 14 patients (2.2%) arrived with a PE diagnosis recently made in the outpatient setting. Patients with PE who arrived at the ED by EMS were less likely to be discharged home within 24h and more likely to die within 30 days than those who arrived by other means. Less than 3% of the EMS group had been diagnosed with PE before ED arrival.