Research by John Radcliffe Hospital in Oxford and the University of Birmingham suggests it is possible for selected patients with intermediate-to-high risk of pulmonary embolism (PE) to be safely managed on an outpatient basis.
The study analysed electronic records for adults with PE managed on an ambulatory care unit over two years. Patients were stratified into low or intermediate-to-high risk groups using the Pulmonary Embolism Severity Index (PESI).
Of 199 PE patients, 74 per cent were ambulated. Thirty-day all-cause mortality was 2 per cent and PE-specific mortality was 1 per cent.
Ambulated patients had lower PESI scores, better vital signs and lower troponin levels. Over a third of ambulated patients had an intermediate-to-high risk PESI score but their all-cause mortality rate was low at 1.9 per cent.
In patients with intermediate-to-high risk, oxygen saturation was higher and pulse rate lower in those who were ambulated. Re-admission rate did not differ between ambulated and admitted patients.
Presenting the findings in ERJ Open Res, the authors say the data demonstrate that selected patients with intermediate-to-high risk PESI scores can be safely ambulated if the patient is involved in shared decision-making regarding the level of acceptable risk.
