Hospital volume and patient outcomes in pulmonary embolism

“…17 During the past few decades, there has been growing evidence that links increased patient volumes to improved outcomes in relation to complex medical and surgical procedures, including heart transplantation, 18 -25 but also increasingly for subspecialty clinics like anticoagulation clinics 24 and heart failure clinics. 25 However, the mechanisms by which these clinics result in improved outcomes remain elusive. 24,25 The improved outcomes seen with SPCs may be at least partly attributable to the expertise that comes with a specialized clinic that deals with a large volume of patients with a single condition.…”

Section: Discussionmentioning

confidence: 99%

“…25 However, the mechanisms by which these clinics result in improved outcomes remain elusive. 24,25 The improved outcomes seen with SPCs may be at least partly attributable to the expertise that comes with a specialized clinic that deals with a large volume of patients with a single condition.…”

Section: Discussionmentioning

confidence: 99%

Organized Outpatient Care

Webster

Saposnik

Kapral

et al. 2011

Stroke

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Background and Purpose-Organized inpatient stroke care decreases mortality and morbidity irrespective of patient age, stroke severity, or stroke subtype. Limited information is available on whether organized outpatient care models such as stroke prevention clinics (SPC) improve outcomes after a transient ischemic attack or ischemic stroke. We compared 1-year mortality and stroke readmission in patients with transient ischemic attack or ischemic stroke referred versus not referred to an SPC. Methods-This was a retrospective cohort study including 16 468 consecutive patients with ischemic stroke or transient ischemic attack who were seen in the emergency department or admitted to a hospital between July 1, 2003 and March 31, 2008 at registry stroke centers (nϭ12) in the province of Ontario. Cox proportional hazards models and propensity score-matched analyses were used to evaluate 1-year mortality and readmission. Results-One-year mortality rates were lower in those referred to SPCs compared with those not referred, even after adjustment for age, sex, ethnic origin, income, comorbid conditions, stroke symptoms and severity, receipt of thrombolysis, stroke unit care, discharge destination, and functional status at discharge (adjusted hazard ratio [HR], 0.67; 95% CI, 0.60 -0.75). Survival analysis after propensity matching showed a 26% reduction in 1-year mortality (HR, 0.74; 95% CI, 0.65-0.84). There were no significant differences in 1-year readmission rates in those referred versus not referred to SPCs. Conclusions-Referral to an SPC is associated with a one-quarter reduction in mortality after ischemic stroke or transient ischemic attack. This supports the argument that outpatient stroke units may prove as effective as their inpatient counterparts. (Stroke. 2011;42:3176-3182.)

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“…It is a major healthcare problem with an estimated incidence of 23-69 cases per 100 000 population annually in the USA [1]. PE and deep venous thrombosis (DVT) are considered as a continuum of the same clinical entity, namely venous thromboembolism.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic characteristics of lower limb venous compression ultrasonography in suspected pulmonary embolism: a meta‐analysis

Rodrigues¹,

Alzuphar²,

Combescure³

et al. 2016

Journal of Thrombosis and Haemostasis

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To cite this article: Da Costa Rodrigues J, Alzuphar S, Combescure C, Le Gal G, Perrier A. Diagnostic characteristics of lower limb venous compression ultrasonography in suspected pulmonary embolism: a meta-analysis. J Thromb Haemost 2016; 14: 1765-72. Essentials• Lower limb ultrasonography (CUS) could be useful in suspected pulmonary embolism (PE).• We performed a metaanalysis on the diagnostic characteristics of CUS in suspected PE.• With a sensitivity of 41%, proximal CUS would be positive in one of every 7.3 patients.• Complete CUS has a higher sensitivity but specificity for PE is too low to use it in suspected PE. , 36-46%) with strong heterogeneity (I square, 79%). Specificity of proximal CUS was 96% (95% CI, 94-98%). The overall positive likelihood ratio for proximal CUS was 11.9 (95% CI, 7.1-19.8), whereas the overall negative likelihood ratio was 0.6 (95% CI, 0.5-0.7). The sensitivity of whole-leg CUS was 79% (95% CI, 24-98%) and specificity was 84% (95% CI, 76-90%). Conclusions: Proximal CUS has low sensitivity and cannot be used to rule out PE. Nevertheless, its high specificity allows confirming PE, which may be useful in patients with contraindications to CT angiography. Whole-leg CUS has a higher sensitivity but low specificity for PE and can therefore not be recommended.

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Hospital volume and patient outcomes in pulmonary embolism

Cited by 21 publications

References 31 publications

The role of ST-segment elevation in lead aVR in the risk assessment of patients with acute pulmonary embolism

The role of ST-segment elevation in lead aVR in the risk assessment of patients with acute pulmonary embolism

Organized Outpatient Care

Diagnostic characteristics of lower limb venous compression ultrasonography in suspected pulmonary embolism: a meta‐analysis

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