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A retrospective analysis of outcomes in low- and intermediate–high-risk pulmonary embolism patients managed on an ambulatory medical unit in the UK

Michael E. Reschen, Jonathan Raby, Jordan Bowen, Sudhir Singh, Daniel Lasserson, Christopher A. O'Callaghan
ERJ Open Research 2019 5: 00184-2018; DOI: 10.1183/23120541.00184-2018
Michael E. Reschen
1Dept of Acute General Medicine, John Radcliffe Hospital, Oxford University NHS Hospitals Foundation Trust, Oxford, UK
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  • For correspondence: michael.reschen@ouh.nhs.uk
Jonathan Raby
1Dept of Acute General Medicine, John Radcliffe Hospital, Oxford University NHS Hospitals Foundation Trust, Oxford, UK
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Jordan Bowen
1Dept of Acute General Medicine, John Radcliffe Hospital, Oxford University NHS Hospitals Foundation Trust, Oxford, UK
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Sudhir Singh
1Dept of Acute General Medicine, John Radcliffe Hospital, Oxford University NHS Hospitals Foundation Trust, Oxford, UK
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Daniel Lasserson
2Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Christopher A. O'Callaghan
3Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
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  • Article
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Tables

  • TABLE 1

    Characteristics of ambulated and admitted patients

    VariableAmbulated (n=136)Admitted (n=51)p-value
    Age years (mean)61.365.80.14
    Male gender65 (47.8)23 (45.1)0.87
    Pulse rate beats·min−182.493.10.0001
    Systolic BP mmHg137.3136.20.73
    Oxygen saturation %95.993.60.000005
    Use of oxygen2 (1.5)19 (37.3)0.0001
    Respiratory rate breaths·min−117.820.00.0001
    Temperature °C36.436.60.03
    Altered mental status0 (0)1 (1.8)0.27
    Heart failure6 (4.4)7 (13.7)0.057
    Cancer27 (19.9)9 (17.6)0.89
    Lung disease26 (19.1)13 (25.5)0.45
    PESI score79.692.00.014
    Intermediate-to-high risk patients52 (38.2)29 (56.9)0.66
    Troponin ng·mL−10.003 (n=79)0.087 (n=34)0.7×10−6
    Morning arrival91 (66.9)19 (37.3)0.0005
    Re-admission rate13 (9.6)2 (3.9)0.36
    All-cause mortality1 (0.7)3 (5.9)0.0625

    Data is presented as n or n (%) unless otherwise stated. BP: blood pressure. PESI: Pulmonary Embolism Severity Index.

    • TABLE 2

      Radiological findings in ambulated and admitted patients

      Radiological findingAmbulatedAdmittedp-value
      Bilateral#91/134 (67.9)38/49 (77.6)0.28
      RV strain¶24/129 (18.6)15/50 (30)0.15
      Saddle embolus¶3/129 (2.3)1/50 (2)1.0
      Sub-segmental¶12/128 (9.4)3/50 (6)0.67
      Incidental finding¶8/136 (5.9)2/50 (4)1.0

      Data is presented as n/n (%). RV: right-ventricular. #: finding based on computed tomography pulmonary angiography (CTPA) or nuclear perfusion scanning; ¶: finding based on CTPA.

      • TABLE 3

        Comparison of patients with a non-low risk Pulmonary Embolism Severity Index (PESI) score who were ambulated or admitted

        VariableAmbulated (n=52)Admitted (n=29)p-value
        Age years (mean)74.676.20.53
        Male gender28 (53.8)11 (38)0.63
        Pulse rate beats·min−184.3950.003
        Systolic BP mmHg136.9137.40.91
        Oxygen saturation %95.392.40.001
        Use of oxygen2 (3.8)12 (41.3)0.0007
        Respiratory rate breaths·min−11820.90.004
        Temperature °C36.236.50.069
        Altered mental status0 (0)1 (3.4)0.36
        Heart failure5 (9.6)7 (24.1)0.15
        Cancer26 (50)9 (31)0.11
        Lung disease20 (38.4)11 (38)0.85
        PESI score110.8114.10.51
        Troponin ng·mL−1 (n=22)0.010.070.06

        Data is presented as n or n (%), unless otherwise stated. BP: blood pressure.

        • TABLE 4

          Detailed analysis of patients who died within 30 days of ambulatory assessment unit attendance

          PatientAdmission statusAge years (mean)PESI scoreComorbidityCause of deathTime to death daysScan
          1Admitted7070NilPE1No scan
          2Admitted80103LungPulmonary fibrosis21Bilateral sub-segmental
          3Admitted83130LungPE1Bilateral
          4Ambulated58118Metastatic cancerSepsis16Unilateral

          PESI: Pulmonary Embolism Severity Index; PE: pulmonary embolism.

          • TABLE 5

            Comparison of severity factors in surviving patients and patients deceased within 30 days of ambulatory assessment unit attendance with pulmonary embolism (PE)

            VariableSurviving (n=183)Deceased (n=4)p-value
            Age years (mean)62.372.750.25
            PESI score82.3105.20.15
            Cancer35 (19.1)1 (25)0.58
            Heart failure13 (7.1)0 (0)1.0
            Lung disease37 (20)2 (50)0.19
            Ambulated135 (74)1 (25)0.063
            Troponin ng·mL−10.027 (n=110)0.07 (n=3)0.40
            D-dimer ng·mL−1612092610.54
            Oxygen use19 (10.4)2 (50)0.063
            Saddle embolus4/176 (2.3)0/3 (0)1.0
            Right-heart strain39/175 (22.3)0/3 (0)1.0
            Bilateral PE127/180 (70.1)2/3 (66.7)1.0
            Sub-segmental14/175 (8)1/3 (33.3)0.23
            Incidental finding10/183 (5.5)0/4 (0)1.0

            Data is presented as n, n (%) or n/n (%), unless otherwise stated. PESI: Pulmonary Embolism Severity Index.

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            A retrospective analysis of outcomes in low- and intermediate–high-risk pulmonary embolism patients managed on an ambulatory medical unit in the UK
            Michael E. Reschen, Jonathan Raby, Jordan Bowen, Sudhir Singh, Daniel Lasserson, Christopher A. O'Callaghan
            ERJ Open Research Apr 2019, 5 (2) 00184-2018; DOI: 10.1183/23120541.00184-2018

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            A retrospective analysis of outcomes in low- and intermediate–high-risk pulmonary embolism patients managed on an ambulatory medical unit in the UK
            Michael E. Reschen, Jonathan Raby, Jordan Bowen, Sudhir Singh, Daniel Lasserson, Christopher A. O'Callaghan
            ERJ Open Research Apr 2019, 5 (2) 00184-2018; DOI: 10.1183/23120541.00184-2018
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