Characterizing Acute Pulmonary Embolism Cases Diagnosed at an Emergency Department Revisit Using a Statewide Clinical Registry - 19/07/24
, Adrian D. Haimovich, MD, PhD c, Courtney W. Mangus, MD d, Christopher Fung, MD b, Neil Kamdar, MS e, Prashant V. Mahajan, MD, MBA b, Keith E. Kocher, MD, MPH b, fAbstract |
Study objective |
To assess the rate and characteristics of acute pulmonary embolism (PE) cases diagnosed in the emergency department (ED) following an ED discharge visit within 10 days.
Methods |
This is a retrospective analysis of 40 EDs in a statewide clinical registry from 2017 to 2022. We identified adult patients with acute PEs diagnosed in the ED. We assessed PE cases wherein a prior ED visit for the same patient resulting in discharge had taken place within 10 days without interval hospitalization. We then characterized the overall rate of revisit PE cases per overall acute PE cases and per 10,000 ED discharges. We also reported on subgroups of revisit cases where the preceding visit resulted in diagnosis of COVID-19, other cardiopulmonary conditions, and cardiopulmonary symptom codes (eg, chest pain, unspecified).
Results |
Of 24,525 acute PEs, 1,202 (4.9%, 95% confidence interval [CI] 4.6% to 5.2%) had an ED discharge within the preceding 10 days (2.0 per 10,000 ED discharges, 95% CI 1.9 to 2.1). Two hundred thirty-three (19.4%) were originally discharged with a COVID-19 diagnosis, 107 (8.9%) were originally discharged with another cardiopulmonary condition, and 201 (16.7%) were cases discharged with a nonspecific cardiopulmonary symptom code. Discharges with diagnoses of COVID-19, pneumonia, and pleural effusion had higher rates of revisits with acute PE.
Conclusion |
In this retrospective analysis, about 1 in 20 acute PEs and 2 in 10,000 ED discharges were associated with an ED revisit for acute PE. Some cases may represent potential diagnostic opportunities, whereas others may be progression of disease, risk factors for PE, or unrelated.
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| Please see page XX for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Lauren M. Westafer, DO, MS. Specific detailed information about possible conflicts of interest for individual editors is available at editors. |
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| Author contributions: ATJ, ADH, and KEK conceived the study. ATJ, CF, and NK performed the analyses. ATJ, ADH, and CWM prepared the manuscript. All authors contributed to its critical revision. ATJ takes responsibility for the manuscript as a whole. |
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| Data sharing statement: MEDIC data for this study are not available for sharing. Code used to prepare results will be shared on request. Inquiries regarding use of the MEDIC data registry for future research investigations can be submitted to the MEDIC Coordinating Center. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals' policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). |
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