Abstract
Background. The Pulmonary Embolism Severity Index (PESI) score can risk-stratify patients with PE but its widespread use is uncertain. With the PESI, we compared length of hospital stay between low, moderate, and high risk PE patients and determined the number of low risk PE patients who were discharged early. Methods. PE patients admitted to St. Joseph Mercy Oakland Hospital from January 2005 to August 2010 were screened. PESI score stratified acute PE patients into low (<85), moderate (86–105), and high (>105) risk categories and their length of hospital stay was compared. Patients with low risk PE discharged early (≤3 days) were calculated. Results. Among 315 PE patients, 51.7% were at low risk. No significant difference in hospital stay between low (7.11 ± 3 d) and moderate (6.88 ± 2.9 d) risk, p > 0.05, as well as low and high risk (7.28 ± 3.0 d), p > 0.05, was found. 9% of low risk patients were discharged ≤ 3 days. Conclusions. There was no significant difference in length of hospital stay between low and high risk groups and only a small number of low risk patients were discharged from the hospital early suggesting that risk tools like PESI may not have a widespread use.
Highlights
Pulmonary embolism (PE) is a common contributor to inpatient disease burden in the US with an annual incidence of 69 per 100,000 patients [1]
By using one-way Analysis of Variance (ANOVA) analysis testing, we found that there was a statistically significant difference between the mean lengths of hospital stay in our 3 different pulmonary embolism risk groups stratified by the Pulmonary Embolism Severity Index (PESI) score with F(2, 312) = 3.702, p = 0.026 (Figure 1)
The least common presenting symptom in the study group was syncope (6%) but when present it was most commonly seen in high risk (13%) followed by moderate risk (5%) and low risk (3.7%) patients (Table 2). In this retrospective observational study, we found that the average length of hospital stay for patients who presented with an acute PE was 7 days which was similar to previous reports [13]
Summary
Pulmonary embolism (PE) is a common contributor to inpatient disease burden in the US with an annual incidence of 69 per 100,000 patients [1]. Among the various available tools for prognostication, the “Pulmonary Embolism Severity Index (PESI)” is one of the most extensively validated clinical scores [7,8,9,10] It boasts a high negative predictive value (NPV) of the lowest PESI classes I and II [11, 12] making it a reliable resource to identify low risk PE patients. There was no significant difference in length of hospital stay between low and high risk groups and only a small number of low risk patients were discharged from the hospital early suggesting that risk tools like PESI may not have a widespread use
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