Results Of Risk Assessment Research Articles

Setting of import tolerances for hexythiazox in blackberries and raspberries.

In accordance with Article 6 of Regulation (EC) No 396/2005, the applicant Gowan Crop Protection Limited submitted a request to the competent national authority in Finland to set an import tolerance for the active substance hexythiazox in blackberries and raspberries. The data submitted in support of the request were found to be sufficient to derive maximum residue level (MRL) proposals of 3 mg/kg for raspberries and blackberries. Adequate analytical methods for enforcement are available to control the residues of hexythiazox in the plant matrices under consideration at the validated limit of quantification (LOQ) of 0.01 mg/kg. Based on the risk assessment results, EFSA concluded that the intake of residues resulting from the use of hexythiazox according to the reported agricultural practices is unlikely to present a risk to consumer health.

Multimodel-based quantitative source apportionment and risk assessment of soil heavy metals: A reliable method to achieve regional pollution traceability and management

To strengthen the control of pollution sources and promote soil pollution management of agricultural land, this study constructed a comprehensive source apportionment framework, which significantly improved the reliability of potential source analysis compared with the traditional single model. The spatial distribution pattern of agricultural soil heavy metals (SHMs) content in Lintong, a typical river valley city in China, was determined and the degree of contamination was evaluated. A scientific source apportionment methodological framework was constructed through correlation analysis methods together with multiple source apportionment receptor models. Finally, the Monte Carlo simulation method was used to derive the results of the human health risk assessment (HHRA). The results revealed the following: (1) Agricultural soils were moderately and mildly polluted, accounting for 28.8 % and 71.2 % of the total number of sampling points, respectively. (2) The overall correlation of heavy metals (HMs) was strong according to the coupling analysis of the SHMs, in which a strong correlation (0.8–1) was reached among Cu, Ni, Pb, Cr and Zn, indicating that these HMs were most likely homologous or composite. (3) Multimodel analysis of the SHMs sources revealed that the first and second principal components were agricultural (41.36 %) and industrial (19.69 %) sources, respectively, and the remaining principal components were road traffic, natural factors, and atmospheric deposition or surface runoff, respectively. (4) The average comprehensive noncarcinogenic health risk indices for adults and children were 4.2259E-02 and 1.4194E-01, respectively, which were within the slight risk range, indicating that the risk caused by SHMs to the human body can be almost negligible. This study adopted a mixed method to reveal the risk of SHMs pollution and its sources, which provides some reference and technical support for traceability analysis, zoning control, and health risk studies of regional pollutants and is helpful for formulating scientific management measures and targeting control policies.

Risk assessment of flash flood under climate and land use and land cover change in Tianshan Mountains, China

Tianshan Mountains in China (CTM) is one of the flash flood-prone areas worldwide, constraining economic development and threatening human safety. We assessed the short-term and long-term future flash flood risk in CTM using a multi-criteria model combined with future climate and Land use and land cover (LULC). The short-term risk assessment results indicated that moderate, high, and extremely high risk areas were mainly located in the northern foothills of the Tianshan Mountain, the southern Junggar Basin, and the northern Tarim Basin, accounting for about 10 % of the total area. The areas classified as high and extremely high risk were distributed in Ili (10,100 km2), Changji (4838 km2), Bortala (1783 km2), and Urumqi (1505 km2). The spatial distributions of future long-term and short-term flash flood risk are similar. There will be an increase in the flash flood risk from 2020 to 2030, mainly in Ili, Changji, and Hami. The flash flood risk in the CTM will decrease under different scenarios from 2030 to 2070. Historical flash flood data from the 1940s to the 2010s indicated that the results of the risk assessment are reasonable. Abundant precipitation from the westerly circulation and the trumpet-shaped topography drove the flash floods in Bortala-shuanghe(BS), Ili, Changji (west), and Urumqi-wujiaqv(UW). Snowmelt flash floods are another important flash flood type in Changji (West) and UW. The dense water system and the undulating terrain led to rainstorm flash floods in high mountainous areas of Aksu and Kashgar, Hami, Kizilsu, and Changji (east). Cultivated land, population, and roads are important risk receptors. The oases, water resource constraints, and the urban scale discontinuity led to the spatial displacement between hazard and risk. The flash flood risk change in the future is more closely related to LUCC than climate change. This study provides support for flash flood risk assessment and management in CTM and other arid inland areas under changed climate and LULC.

Antibiotic resistance in the Ganga River: Investigation of antibiotic resistant bacteria and antibiotic resistance genes, and public health risk assessment

The Ganga River, sacred to India and supporting 440 million people, faces a severe threat from antibiotic resistance. Here, we have investigated the abundance of antibiotic resistant bacteria (ARB), antibiotic resistant genes (ARGs), and mobile genetic elements (MGEs) in water and sediment samples at 16 different sites across the Ganga River biannually. Furthermore, we investigated the presence of potentially pathogenic ARB at genus level in the Ganga River and conducted a risk assessment for human exposure to ESKAPE pathogens during swimming activities. Among the sites studied, a notably higher abundance of ARB, ARGs, and MGEs was observed downstream of the pristine sites (G1 and G2) due to anthropogenic inputs. A significant positive correlation (p < 0.05) was observed between ARB, ARGs, MGEs, and coliforms, suggesting a close association between faecal contamination and MGEs in the spread of antibiotic resistance in the river. Of the identified, 10,340 isolates, Pseudomonas, Bacillus, Acinetobacter, Pseudoxanthomonas, and Aeromonas were the top five most abundant genera. The dominant potentially pathogenic ARB were Pseudomonas, Acinetobacter, Aeromonas, Stenotrophomonas, and Brevundimonas. The results of the Quantitative Microbial Risk Assessment (QMRA) and the analysis of disability-adjusted life years (DALYs) indicated that Enterobacter cloacae posed the highest risk, followed by Acinetobacter baumannii and Klebsiella pneumoniae. Overall, this study provides quantitative data on antibiotic resistance and human health risks in the Ganga River. The data from this study can serve as a foundational basis for guiding crucial actions and policy recommendations for safeguarding the Ganga River and the well-being of its users.

Characterization, source profiles and risk assessment of polycyclic aromatic hydrocarbons (PAHs) in urban dust of 14 Chinese cities

ABSTRACT Data for 16 USEPA priority PAHs were collected in urban dust from 14 cities in China between 2008 and 2022, and concentration, profile composition, and human health risk were investigated. The mean concentration of PAHs was 6.60 mg kg−1, ranging from 2.88 mg kg−1 to 13.88 mg kg−1, and it was higher than other important cities in neighboring countries of China. Among different individual PAHs, mean fluoranthene (Flr) was dominant, accounting for 15.04%, and low molecular weight PAH (LMW) was almost a third of high molecular weight PAH (HMW). The results of PAH composition profiles suggested that the proportion of different rings of PAHs increased in order: 2-ring PAHs (4.40%)< 6-ring PAHs (15.73%)< 3-ring PAHs (17.77%)< 5-ring PAHs (22.54%)< 4-ring PAHs (39.56%). The results of the source appointment suggested that pyrogenic sources and mixed sources, particularly wood, grass, coal, and diesel combustion, were the main sources of PAHs in urban dust. The results of the health risk assessment illustrated that children were more vulnerable to PAHs, and ingestion was the dominant exposure pathway to PAHs (78.152%, 67.519%, 73.206%, and 72.957% of children, adolescents, adults, and the total lifetime cancer risk (TLCR)). PAH pollution in urban dust from different cities in China was a commonly existing phenomenon, but the mean and maximum of TLCR were acceptable according to the standard established by USEPA (10−4). Based on Monte Carlo simulations, body weight (BW) was the most important uncertain input in three age groups (60.75%-91.22% contribution).

Human errors analysis for remotely controlled ships during collision avoidance

To address human errors in collision avoidance tasks of remotely controlled ships, this study aims to develop a comprehensive framework for human error analysis within the context of autonomous ships. Firstly, the Hierarchical Task Analysis method is utilized to identify crew collision avoidance tasks associated with the traditional ship, and these tasks are then dissected into different operational stages using the Information Decision Action in a Crew cognitive model. Secondly, a combination of the fault hypothesis method and expert opinions are used to identify potential human error that may occur during collision avoidance operations of remotely controlled ships. Thirdly, an integrated approach is proposed to build a quantitative risk assessment model, which combines Failure Mode and Effects Analysis, Evidential Reasoning, and Belief rules-based Bayesian Network. Then, axiomatic analysis is used to verify the robustness and applicability of the risk assessment model. Finally, based on the results of quantitative risk assessment, specific measures are proposed for enhancing the safety of collision avoidance process of remotely controlled ships. The findings show that uncoordinated interactions of human-computer systems during the decision-making stage are a pivotal factor in the collision avoidance process. Therefore, future design efforts for remote-control centre should prioritize improving the clarity of human-computer interaction interfaces.

Practical drought risk assessment and management framework: A step toward sustainable modernization in agricultural water management

A proposed framework to assess and manage risks associated with Agricultural Water Off-farm Conveyance and Distribution Systems (AWOCDS), quantify potential failure due to drought-induced scenarios, and provide short to long-term recovery plans to mitigate drought impacts. It makes an intellectual contribution by creating a new proactive risk assessment focusing specifically on AWOCDS as a crucial part of agricultural water management. The risk assessment comprises two components − risk probability and consequence. The former is calculated by analyzing droughts via the streamflow drought index using the DrinC calculator. The latter is determined through AWOCDS’ performance evaluation using hydraulic simulation via HEC-RAS. Additionally, water distribution is assessed spatiotemporally using adequacy and equity indicators, and an integrated consequence is developed by applying the simple additive weighting method. AWOCDS’ rehabilitation and modernization projects worldwide include three practical practices in its risk management component. These practices involve modifying standard operating procedures (SOPs) by updating maintenance, upgrading manual-based operations, and developing a centralized Model Predictive Controller (MPC) for AWOCDS automatic operation. The proposed framework underwent testing in an arid region. Based on the risk assessment results, the AWOCDS operating system failure rate ranges from 70% to 96% during extreme-severe drought scenarios and 53% to 65% during moderate-mild drought scenarios. Risk management analysis shows that a short-term recovery plan reduces the drought risk by 4% monthly and 3% yearly. However, the risk of failure ranges from 50 to 94% in mild to extreme drought scenarios. Upgrading SOPs decreases impact by 4–11% in extreme, 4–7% in moderate-severe and 7–9% in mild-moderate drought. Automating the operating system with MPC reduces impact by 40–43% and 30–56% in mild-moderate and severe-extreme drought scenarios. This proactive-based strategy can help water managers plan for rehabilitation and improve surface water distribution reliability.

Modification of the existing maximum residue levels for propamocarb in radishes (roots and small leaves).

In accordance with Article 6 of Regulation (EC) No 396/2005, the Federal Public Service (FPS) Health, Food chain Safety and Environment submitted a request to the competent national authority in Belgium (evaluating Member State, EMS) to modify the existing maximum residue levels (MRLs) for the active substance propamocarb in radishes for the residues occurring in radish roots and in small radish leaves (proposed to be classified under the subgroup of Roman rocket/rucola). The data submitted in support of the request were found to be sufficient to derive MRL proposals for radishes and small radish leaves. Adequate analytical methods for enforcement are available to control the residues of propamocarb on the commodities under consideration at the validated limit of quantification (LOQ) of 0.01 mg/kg. Based on the risk assessment results, EFSA concluded that the short-term and long-term intake of residues resulting from the use of propamocarb according to the reported agricultural practice is unlikely to present a risk to consumer health. The chronic consumer risk assessment shall be regarded as indicative since affected by uncertainty related to the data gaps identified in the MRL review.

Evaluating corporate climate risk assessment results: Lessons learned from Taiwan’s top 100 enterprises

In recent years, driven by the Task Force on Climate-related Financial Disclosures (TCFD), climate risk disclosure has developed as a key concrete action among the business community to address climate change. However, such disclosures are often incomplete or misleading, and improvements are needed both in terms of disclosure quantity and quality. One of the fundamental problems is that it is difficult to evaluate the results of corporate climate risk assessment. This study constructs the Evaluation of Corporate Climate Risk Assessment Results (ECCRAR) scheme. It analyzes the sustainability reports and TCFD reports of Taiwan’s 100 largest firms by total market capitalization. The findings reveal significant variation in their physical and transition risk assessment performance. Issues identified include inappropriate scenario settings, assessment tools, and sources of information, as well as flawed or unclear risk assessments. Additionally, there is an overly conservative use of assessment tools, with a heavy reliance on free resources and official graphics (such as hazard potential maps and inundation maps), with extremely low use of transition risk assessment tools and graphics. We also recommend increasing the use of fixed-temperature warming scenarios. The research results provide a useful reference to corporate and government decision makers, and also raise the analytical scheme and new empirical cases for further research.

Performance of indicators used in regular risk assessments for COVID-19 in association with contextual factors.

This study aimed to summarize the results of coronavirus disease 2019 (COVID-19) risk assessments and to examine the associations between risk levels and various indicators, including COVID-19 incidence, risk perception, community mobility, and government policy. The results of the risk assessment and the indicators utilized were summarized. From November 2021 to May 2022, the COVID-19 risk level was evaluated on a weekly basis, and its correlation with these indicators was analyzed. Data were obtained from press releases by the Korea Disease Control and Prevention Agency, regular surveys conducted by Hankook Research, and information available on the Google and Oxford websites. Weekly risk assessments were conducted for 30 weeks, using different indices depending on the phases. Correlation analysis revealed the strongest positive correlation between risk level and risk perception (r=0.841). The risk level from "1-week lead" demonstrated a strong positive correlation with the time-varying reproduction number (Rt). Similarly, the risk level from "week lagged value" showed a strong positive correlation with the number of severe cases in the hospital. At the time of risk assessment, the Rt precedes the risk level, while severe cases in hospitals follow. Therefore, the assessed risk level functioned as an early warning system. Risk perception demonstrated the strongest correlation with the risk level, suggesting consistency throughout the assessment period. Contextual indicators (e.g., risk perception) that consider time lags and implementation scales, could improve the evaluation of future risk assessment results, particularly when there are challenges in reflecting specific situations in coordinated emergency response.

Intelligent management and legal regulation of enterprise green supply chain by fuzzy comprehensive evaluation

This study aims to evaluate the risk levels of intelligent management in Green Supply Chain Management (GSCM) through the application of the Fuzzy Comprehensive Evaluation (FCE) model. It begins by outlining the structure of the green supply chain (GSC), encompassing various components such as suppliers, manufacturers, and distributors, while incorporating considerations of environmental and sustainability factors. Data is collected from Company Y through a questionnaire survey, and the FCE model is employed to assess the risk levels of intelligent management within GSCM. The study identifies that Company Y faces high-risk factors in supply chain management, including customer demand fluctuations, inadequate supplier capacity, and reliance on exclusive suppliers, with a risk rating of 4. Additionally, moderate-risk factors, such as partnerships, policies, cash flow, technological capabilities, and internal production management, were rated at a risk level of 3. Based on the risk assessment results, the study proposes several recommendations for improvement. These include reinforcing the enforcement of environmental policies, establishing mechanisms for supply chain information transparency, and promoting clean production technologies. These recommendations are intended to assist the company in better adhering to environmental regulations and fostering sustainable supply chain development. The study's innovation lies in the successful integration of the FCE model into the supply chain risk assessment framework, effectively combining subjective evaluations with objective data to improve the accuracy of the assessment. The findings provide scientific evidence for companies to manage risks and formulate strategies, while also offering new insights into the multidimensional nature of supply chain risks, encompassing social, economic, environmental, and technological dimensions.

Occupational health risk assessment of exposure to major hazardous chemicals in copper and nickel smelting enterprises

Objective: To evaluate the risk of major chemical exposure positions in copper and nickel smelting enterprises, and provide a basis for risk assessment and prevention control measures. Methods: From September to October 2023, two copper nickel ore smelting enterprises in Xinjiang Uygur Autonomous Region were selected as the research objects. Relevant information on chemicals was collected through occupational hazard field investigations. Qualitative analysis and exposure index methods were used in GBZ/T 298-2017 "Technical Guidelines for Occupational Health Risk Assessment of Chemical Hazardous Factors in the Workplace" to conduct risk assessments on the main chemical exposure positions. The qualitative risk assessment results were checked for consistency using the Weighted Kappa coefficient. Results: The positions with high risk of exposure to hazardous chemicals in copper nickel smelting enterprises are saponification positions exposed to hydrochloric acid in refining processes, black nickel positions exposed to sodium hydroxide, and tail suction positions. The consistency between the two occupational health risk assessment results is poor (Kappa=0.14) . Conclusion: The amount of major hazardous chemicals in copper-nickel smelting enterprises is large, and the occupational health risks caused by exposure are complex and diverse, so the effects of chronic occupational health should be strengthened.

Deciphering the driving factors and probabilistic health risks of potentially toxic elements in arid surface water: Insights from the Tarim River Basin

Potentially toxic elements (PTEs) in surface water in arid areas pose a serious threat to environmental safety and human health within a basin. It is important to determine the factors controlling PTEs and to assess the likelihood that they will pose a risk to human health in order to support the development of environmental protection and risk management strategies. In this study, a structural equation model and Bayesian method were combined to discuss the distribution and probabilistic health risks of PTEs in surface water in arid area, and the Tarim River Basin was taken as a case study. The results show that the average concentrations of As, Co, Cu, and Ni in the surface water in the Tarim River Basin ranged from 0.04 to 2.92 μg/L, which do not exceed the international standard values. However, the maximum value of As (19.20 μg/L) exceeded both the recommended drinking water standards and the Chinese irrigation water standards. Spatially, the high As concentrations were distributed in the upper reaches of the Kashgar River, and the high Co, Cu and Ni concentrations were distributed in reservoirs and lakes on the main stream of the Tarim River. The concentrations of the PTEs in the surface water in the basin were not only affected by random anthropogenic factors such as traffic discharge, agricultural activities and mining industry, but were also directly and indirectly influenced by climatic factors. The results of the probabilistic health risk assessment showed that the 95th percentile the total hazard index for infants exceeded the allowable value of 1, and the total carcinogenic risk of PTEs exposure in four age groups was at the notable level. In this study, we conducted a comprehensive analysis of the controlling factors and health risks associated with PTEs in surface water in the Tarim River Basin, and the findings are expected to provide a scientific basis for regional water environment management and safety control.

Probabilistic seismic risk analysis of electrical substations considering equipment-to-equipment seismic failure correlations

When an earthquake occurs, electrical equipment in a substation exhibits a certain level of seismic failure correlation since they suffer similar ground motions and share similar structural characteristics. However, this equipment-to-equipment seismic failure correlation (E2ESFC) was neglected in previous substation-level probabilistic seismic risk analyses due to the lack of awareness and practical approach. To investigate the effect of different degrees of the E2ESFC on the substation seismic risk, an efficient method for considering partially correlated seismic failure was proposed. The concepts of “damage demand probability” and “damage capacity probability” were derived from the equipment's fragility curve. Then the partial correlation of equipment's capacity probabilities can be easily introduced and incorporated into the substation-level risk analysis through the combination of Copula functions and the Monte Carlo simulation. A case study on a real-world 220/110 kV substation using an equi-correlation model demonstrated that ignoring the E2ESFC among the same type of equipment will lead to an underestimate of the probability of seeing high seismic loss. Furthermore, a general method to assess the E2ESFC coefficients between equipment was also proposed, laying the foundation to facilitate applications of the introduced E2ESFC simulation method and to generate a more reliable system risk assessment result.

Appraisal of contamination, hydrogeochemistry, and Monte Carlo simulation of health risks of groundwater in a lithium-rich ore area.

This study incorporated hydrogeochemical facies, the entropy-weighted water quality index (EWQI), multivariate statistics, and probabilistic human exposure assessment to investigate hydrogeochemistry, analyze groundwater quality, and estimate potential risks to human health in a lithium-rich ore area (Jadar River basin, Serbia). The findings designated the Ca·Mg-HCO3 hydrogeochemical type as the predominant type of groundwater, in which rock weathering and evaporation control the major ion chemistry. Due to the weathering of a lithium-rich mineral (Jadarite), the lithium content in the groundwater was very high, up to 567mg/L, with a median value of 4.3mg/L. According to the calculated EWQI, 86.4% of the samples belong to poor and extremely poor quality water for drinking. Geospatial mapping of the studied area uncovered several hotspots of severely contaminated groundwater. The risk assessment results show that groundwater contaminants pose significant non-carcinogenic and carcinogenic human health risks to residents, with most samples exceeding the allowable limits for the hazard index (HI) and the incremental lifetime cancer risk (ILCR). The ingestion exposure pathway has been identified as a critical contaminant route. Monte Carlo risk simulation made apparent that the likelihood of developing cancerous diseases is very high for both age groups. Sensitivity analysis highlighted ingestion rate and human body weight as the two most influential exposure factors on the variability of health risk assessment outcomes.

Toward zero traffic deaths and disabilities with active and passive safety technologies in the association of southeast Asian nations

Road traffic crashes caused more than 108,000 deaths and 6,200,000 injuries resulting in 7.7 million disability-adjusted life years (DALYs) lost in the Association of Southeast Asian Nations (ASEAN) in 2019. This study estimates that 59 % of these casualties could have been avoided if all vehicles were designed to provide crash protection equivalent to that of the best vehicle safety design in their class and all road users adhered to safety best practices. Results of comparative risk assessments indicate that the application of safety technologies that are considered high priority by the United Nations (anti-lock braking, electronic stability control, occupant restraints, frontal and side airbags, crashworthiness, side-door beam, side structure and padding, and helmets) can save 34,373 lives and avert 2.5 million DALYs annually in ASEAN. While implementing Autonomous emergency braking and lane keeping assistance systems would provide additional reductions estimated at 13,077 fewer deaths and 1,021,220 fewer DALYs, speed-limitation systems would have a larger additional benefit, estimated at 21,394 lives saved and 1,382,530 fewer DALYs. The investigated technologies can be among the best approaches toward zero traffic deaths and can elevate public health burdens in low and middle-income countries.

Modification of the existing maximum residue levels for picloram in animal commodities and honey

Abstract In accordance with Article 6 of Regulation (EC) No 396/2005, the applicant Corteva Agriscience International Sàrl submitted a request to the competent national authority in the Netherlands to modify the existing maximum residue levels (MRLs) in certain animal commodities (fat and liver) and honey. The data submitted in support of the request were found to be sufficient to derive an MRL proposal for honey. Adequate analytical methods for enforcement are available to control the residues according to the residue definition for enforcement proposed as ‘picloram, free and conjugated, expressed as picloram’ in honey at the validated limit of quantification (LOQ) of 0.01 mg/kg. For the commodities of animal origin, although the submitted data were found to be sufficient, EFSA concluded that no change of the existing MRLs was necessary. Based on the risk assessment results, EFSA concluded that the short‐term and long‐term intake of residues expected in honey, resulting from the existing uses of picloram on melliferous crops, is unlikely to present a risk to consumer health.

Modification of the existing maximum residue level for flonicamid in honey.

In accordance with Article 6 of Regulation (EC) No 396/2005, the applicant ISK Biosciences Europe N.V. submitted a request to the competent national authority in Finland to modify the existing maximum residue level (MRL) for the active substance flonicamid in honey. The data submitted in support of the request were not found appropriate to derive an MRL proposal for honey. The assessment was complemented by an analysis of the monitoring data available from the EU monitoring programmes (conducted during 2009-2023). The results from the monitoring data analysis suggest that the current MRL is still sufficient to account for the residue uptake in honey resulting from plant protection products uses of flonicamid on melliferious crops. Adequate analytical methods for enforcement are available to control the residues of flonicamid in honey according to the residue definition as the sum of flonicamid, TFNA and TFNG, expressed as flonicamid at the validated limit of quantification (LOQ) of 0.01 mg/kg for each compound. Based on the risk assessment results, EFSA concluded that the short-term and long-term intake of residues in honey at a level of 0.05 mg/kg according to the monitoring data is unlikely to present a risk to consumer health.

Modification of the existing maximum residue levels for dichlorprop-P in cereal grains.

In accordance with Article 6 of Regulation (EC) No 396/2005, the applicant Nufarm Crop Products UK Ltd. submitted a request to the competent national authority in Italy to modify the existing maximum residue levels (MRLs) for the active substance dichlorprop-P in barley, oat, rye and wheat grain. The data submitted in support of the request were found to be sufficient to derive MRL proposals for these cereal grains. Adequate analytical methods for enforcement are available to control the residues of dichlorprop-P in the commodities under consideration at the validated limit of quantification (LOQ) of 0.01 mg/kg and in animal matrices at the validated LOQ of 0.01 mg/kg. Based on the risk assessment results, the European Food Safety Authority (EFSA) concluded that the short-term and long-term intake of residues resulting from the use of dichlorprop-P-2-ethylhexyl (dichlorprop-P 2-EHE) according to the reported agricultural practices is unlikely to present a risk to consumer health.

Risk assessment and management strategies in older patients with acute pulmonary embolism

BackgroundManaging older patients with acute pulmonary embolism (PE) is challenging due to their underrepresentation in clinical trials, comorbidities, and increased complication risk. ObjectivesTo evaluate risk assessment and management outcomes in older patients with PE focusing on home and reperfusion treatment. MethodsA retrospective analysis was conducted on patients aged 70 years or older diagnosed with acute PE at an academic medical center (2015-2022). ResultsIn total, 242 patients with a mean age of 77 years were included. All 59 patients with negative Hestia criteria were discharged ≤24 hours, and in total, 81 patients (35%) received home treatment. Among these 14-day mortality and recurrent venous thromboembolism were 0% and major bleeding occurred in 1.3% (1 patient, 95% CI: 0.11-6.1). European Society of Cardiology risk classification showed 9 low-risk (3.9%), 199 intermediate-risk (87%), and 20 high-risk (8.8) patients with PE. In 5 of the 20 high-risk patients, hypotension was mainly caused by another condition, that is, sepsis. Eight high-risk patients received reperfusion therapy. The 14-day mortality rate was 51% in high-risk patients (95% CI: 27-71); 5 of 8 patients receiving reperfusion treatment died within 5 days. Patients with an Acute Presenting Older Patient score of ≥45% had higher 14-day mortality (28%; 95% CI: 12-46) compared with <45% (3.2%; 95% CI: 0.85-8.3; hazard ratios: 10.2; 95% CI: 2.6-39). ConclusionSelecting for home treatment using Hestia criteria was safe for older patients with PE in our cohort. Mortality in the high-risk group was high also when receiving reperfusion treatment. The European Society of Cardiology risk classification and Acute Presenting Older Patient score identified patients at higher mortality risk, suggesting their potential utility in clinical decision-making.