Identification and Outcomes of Low-Risk PE Admissions: A Community Experience

Introduction: Approximately 900,000 pulmonary emboli (PEs) are diagnosed in the United States annually, and the incidence is increasing. However, the overall mortality from PEs has been decreasing.Many patients are still hospitalized for the diagnosis, for a mean length of 4 days, and a mean total cost of hospitalization of $8674. Several risk prognostication models have been developed to guide the intensity of care and appropriateness of early discharge, as well as complete ambulatory treatment for these patients, including but not limited to the simplified PE severity index (sPESI). We performed a retrospective study to evaluate the sPESI for patients hospitalized in 4 community hospitals between 2013 and 2020.

Methods: The admissions database of Crozer-Chester Medical Center system across four hospitals was scanned for admissions with PE between the years 2013 and 2020. ICD9 and ICD-10 codes of PE were used. 946 patients found with the admitting diagnosis code of PE were included. After excluding patients due to duplicate charts, coding errors, and patients with suspicion of PE but ruled out on definitive testing (n=100), a cohort of 846 patients was attained, to which risk-stratification using sPESI was applied. These admissions were scored using the simplified PESI index, and main outcomes included were length of stay, disposition and condition at diagnosis and readmission at 30 days.

Results: 353 (41.7%) patients of this cohort were found to be sPESI 0, or low risk admissions. The number of men and women with sPESI 0 admissions was comparable (167 men and 185 women). The mean age of this low-risk cohort was 49.61 years, with a mean length of stay spanning 3.34 days. 91.5% of this cohort was discharged directly to home, and had a 30-day re-admission rate of 8.2%. No deaths were reported in this sPESI 0 sub-group.

Conclusions: A significantly high number of admissions of low-risk PEs were observed in the community setting, even higher than reported in other studies. These patients had favorable outcomes, with low re-admission rates. Patients with low-risk PE in our study were significantly younger (49.61 years) than the overall PE population (77.6 years.)Their readmission rates were also significantly lower (8.2%) than overall readmission rates for patients with PE (13.6%). This sPESI 0 cohort had very low mortality rates, with no deaths being reported on admission or re-admission. An impetus to promptly risk stratify these low-risk patients in the emergency department setting, and to implement comprehensive home management is clearly needed in the community setting. Current data is scant, and further research is required to identify reasons and barriers of these high rates of low-risk PE hospitalizations.

No relevant conflicts of interest to declare.