Annals of Internal MedicineTrends in Discharge Rates for Acute Pulmonary Embolism in US Emergency Departments

Understanding Outpatient Management of Acute Pulmonary Embolism

Recent research conducted on the outpatient management of low-risk acute pulmonary embolism (PE) highlights the constant discharge rates from emergency departments (EDs) in the United States despite proven safety and effectiveness. This study, utilizing data from US EDs between 2012 and 2020, sheds light on the real-world trends and identifies baseline characteristics associated with ED discharge for acute PE patients.

Study Design:

• Participants: The study focused on patients with ED visits for acute PE between 2012 and 2020 across US EDs participating in the National Hospital Ambulatory Medical Care Survey.
• Analysis: A serial cross-sectional analysis was conducted to assess national trends in discharge rates and explore factors influencing ED discharge decisions.

Key Findings:

• Discharge Rates: Discharge rates for acute PE remained constant, with little change from 38.2% between 2012 and 2014 to 33.4% between 2018 and 2020.
• Predictive Factors: No baseline characteristics, including risk stratification scores, significantly predicted ED discharge likelihood. However, patients at teaching hospitals and those with private insurance were more likely to be discharged with oral anticoagulation.
• Low-risk Patient Management: Only about one third of patients categorized as low-risk based on various scores were discharged from the ED for outpatient management.

HCN Medical Memo
Despite clear guidelines and evidence supporting the safety of outpatient management for low-risk acute PE, this practice remains underutilized, indicating a need for increased awareness and implementation of existing protocols to improve patient care and resource utilization.

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