Early discharge of patients with pulmonary embolism in daily clinical practice: A prospective observational study comparing clinical gestalt and clinical rules

Thrombosis Research
Simone VanniStefano Grifoni

Abstract

To estimate the efficiency and safety of clinicians' gestalt in the identification of patients with pulmonary embolism (PE) candidates for early discharge and to compare the efficiency and safety of clinical gestalt with that of the Pulmonary Embolism Severity Index (PESI), the simplified PESI (sPESI) and the Hestia criteria (HC). Consecutive adult patients presenting to the emergency department of four Italian hospitals with confirmed diagnosis of PE were included. Data for PESI, sPESI and HC assessment were prospectively collected. Patients were managed according to the clinical gestalt of the attending physician, independent of the results of PESI, sPESI and HC. Efficiency was defined as the prevalence of candidates to early discharge. The primary safety measure was the incidence of a composite of venous thromboembolic recurrence, major haemorrhage or all-cause mortality within 30 days. Out of 547 included patients, 178 (32.5%) were judged to be at low risk and discharged within 48 h from presentation. HC identified a higher proportion (41.7%) whereas both PESI (24.1%) and sPESI (18.3%) identified a lower proportion of candidates for early discharge when compared to clinical gestalt (P < 0.01 for all). The incidence of the s...Continue Reading

Citations

Mar 10, 2019·Journal of Thrombosis and Haemostasis : JTH·W Frank Peacock, Adam J Singer
Aug 12, 2020·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Brandon C MaughanJeffrey A Kline
Jul 1, 2020·Thrombosis and Haemostasis·Stephan V HendriksUNKNOWN Hestia/Vesta investigators
Dec 18, 2020·Annals of the American Thoracic Society·Lukasz A MycAlexandra Kadl
Oct 31, 2020·Journal of the American College of Cardiology·Elizabeth Renner, Geoffrey D Barnes
Jan 13, 2022·Journal of General Internal Medicine·David R VinsonUNKNOWN PEPC Investigators of the KP CREST Network

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