Investigating and managing suspected pulmonary embolism in an outpatient setting: the Leicester experience

Abstract

Having established an ambulatory service for patients with suspected and proven PE, we reviewed our outcomes. All patients referred from June 2010 to May 2012 were analysed. Of 971 patients referred, 905 underwent complete assessment (66 admitted as ineligible). 754 (77.7%) patients were discharged and required no follow-up. 96 (10.6%) patients had PE confirmed of whom 70 (72.9%) were managed as outpatients. 14 (1.6%) patients have died since attending the clinic; no death was related to PE. This audit shows that ambulatory investigation and management of selected low risk patients with suspected PE is safe and reduces hospital admissions.

Value of Cardiac Troponin and sPESI in Treatment of Pulmonary Thromboembolism at Outpatient Setting

“…No mortality occurred in these patients during a follow-up of 90 days [14]. It may be concluded that mortality decreases when the number of restrictions for outpatient treatment are increased.…”

Multicenter Trial of Rivaroxaban for Early Discharge of Pulmonary Embolism From the Emergency Department (MERCURY PE): Rationale and Design

“…The safety and efficacy of such an approach is further supported by a large randomized controlled trial as well as a recent small observational study . Indeed, outpatient management of low‐risk PE patients is quite common in both Europe and Canada …”

British Thoracic Society Guideline for the initial outpatient management of pulmonary embolism (PE)

“…Of the 971 patients referred, 871 were treated entirely as OPs (89.7%) 12 . The authors report previous pilot work suggesting this cohort of patients previously had a mean LOS of 1.59 days, resulting in 692 saved bed-days per year.…”

“…Vali et al 12 used a modified version of the PESI in combination with a series of clinical exclusion criteria (pulse <110 bpm, SBP >100 mm Hg, oxygen saturations >92% on air, respiratory rate <30 bpm, no syncope, normal troponin, no large central clot or right heart strain on CTPA, no compliance or follow-up issues, low risk of bleeding, did not require admission for other comorbid conditions) to identify patients with suspected PE who were suitable for OP management. Using these criteria they managed 72.9% of patients with confirmed PE as OPs with PE-specific mortality of 0%.…”

“…A retrospective review of outcomes from an established OP PE service assessed 905 patients referred with suspected PE of whom 562 were considered at intermediate or high risk for PE and underwent imaging following a dose of LMWH 12 . Same-day imaging was performed in 62.8%, with 89% undergoing imaging the same or next day.…”