Introduction Management of Pulmonary Embolism (PE) has been until recently largely in-patient based and markedly affects length of stay in these patients. Recent evidence suggests that suspected or confirmed cases of PE can be managed out of hospital1, 2. We present our experience of outpatient management of PE in a small district general hospital.
Method We identified 35 patients investigated/treated for PE as outpatient between March 2012 and June 2013. Demographic and clinical data was collected from case notes. Statistical analysis was performed on Medcalc based on normality.
Result The table below profiles our cohort. (Table)
There was a high PE diagnosis (51%) within our cohort despite most patients being in a low PESI class. Clinical decision made in high PESI class to manage as outpatient. PE was diagnosed in 4 of the 5(80%) patients with a raised Troponin level (odds ratio 1.66, statistically not significant). Out of 21 GP referrals, 13(61.9%) had a positive scan as opposed to 5 of the 13 (38.4%)patients referred from hospital, however this did not attain statistical significance (odds ratio 3.25, p = 0.12). The equivocal CTPA was deemed not PE on clinical grounds. All patients were reviewed by a Registrar or Consultant prior to discharge. No mortality recorded till date. One patient re-presented with exacerbation of Asthma.
Discussion Carefully selected patients with suspected or confirmed PE can be managed out of hospital. Based on time to imaging, atleast 28 unnecessary inpatient days were avoided leading to £9800 saved and a high pick up rate. In our experience, mortality and re-admission rates have been minimal highlighting outpatient management as a safe and cost-effective strategy in management of PE.
Safety of outpatient treatment in acute pulmonary embolism. Erkens PM, Gandara E, Wells P, et al. J Thromb Haemost, Nov 2010, vol/is. 8/11(2412–7), 1538–7836
Outpatient Management of suspected Pulmonary Embolism at a District General Hospital; A Two Month Review. JA Benjamin, A Griffiths, S power, et al. Thorax 2012;67:A123 doi:10.1136/thoraxjnl-2013-204457.305