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BMC Pulm Med. 2017 Feb 13;17(1):37. doi: 10.1186/s12890-017-0379-5.

Observation management of pulmonary embolism and agreement with claims-based and clinical risk stratification criteria in United States patients: a retrospective analysis.

Author information

1
University of Connecticut School of Pharmacy, 69 North Eagleville Road, Unit 3092, Storrs, CT, 06269, USA.
2
University of Connecticut School of Pharmacy, 69 North Eagleville Road, Unit 3092, Storrs, CT, 06269, USA. craig.coleman@hhchealth.org.
3
Department of Emergency Medicine, Baylor College of Medicine, 1504 Taub Loop, Houston, TX, USA.
4
Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, 501 Smyth Road, Box 206, Ottawa, ON, Canada.
5
Janssen Scientific Affairs, LLC, 1000 Route 202, Raritan, NJ, USA.
6
New England Health Analytics, LLC, Granby, CT, USA.
7
Department of Emergency Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, USA.

Abstract

BACKGROUND:

Guidelines suggest observation stays are appropriate for pulmonary embolism (PE) patients at low-risk for early mortality. We sought to assess agreement between United States (US) observation management of PE and claims-based and clinical risk stratification criteria.

METHODS:

Using US Premier data from 11/2012 to 3/2015, we identified adult observation stay patients with a primary diagnosis of PE, ≥1 PE diagnostic test claim and evidence of PE treatment. The proportion of patients at high-risk was assessed using the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) equation and high-risk characteristics (age > 80 years, heart failure, chronic lung disease, renal or liver disease, high-risk for bleeding, cancer or need for thrombolysis/embolectomy).

RESULTS:

We identified 1633 PE patients managed through an observation stay. Despite their observation status, IMPACT classified 46.4% as high-risk for early mortality and 33.3% had ≥1 high-risk characteristic. Co-morbid heart failure, renal or liver disease, high-risk for major bleeding, cancer and hemodynamic instability were low (each <4.5%), but 7.8% were >80 years-of-age and 19.4% had chronic lung disease.

CONCLUSION:

Many PE patients selected for management in observation stay units appeared to have clinical characteristics suggestive of higher-risk for mortality based upon published claims-based and clinical risk stratification criteria.

KEYWORDS:

Mortality; Observation stays; Pulmonary embolism; Resource utilization

PMID:
28193193
PMCID:
PMC5307802
DOI:
10.1186/s12890-017-0379-5
[Indexed for MEDLINE]
Free PMC Article

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