National trends in emergency room diagnosis of pulmonary embolism, 2001–2010: a cross-sectional study

Abstract

BackgroundLittle is known about the United States diagnosis and burden of pulmonary embolism (PE) in the emergency department (ED), and their evolution over the past decade. We examined nationally representative data to evaluate factors associated with and trends in ED diagnosis of PE.MethodsWe conducted a cross-sectional study using National Hospital Ambulatory Medical Care Survey (NHAMCS) data from January 1, 2001 to December 31, 2010. We identified all ED patient visits where PE was diagnosed and corresponding demographic, hemodynamic, testing and disposition data. Analyses were performed using descriptive statistics and multivariable logistic regression.ResultsDuring the study period 988,000 weighted patient visits with diagnosis of PE were identified. Among patients with an ED visit, the likelihood of having a diagnosis of PE per year increased significantly from 2001 to 2010 (odds ratio [OR] 1.091, 95% confidence interval [CI] 1.034-1.152, P = 0.002 for trend) when adjusted for demographic and hospital information. In contrast, when further adjusted for the use of computed tomography (CT) among patients in the ED, the likelihood of having a diagnosis of PE per year did not change (OR 1.041, 95% CI 0.987-1.097, P = 0.14). Overall, 75.1% of patients seen with a diagnosis of PE were hemodynamically stable; 86% were admitted with an in-hospital death rate under 3%.ConclusionsThe proportion of ED visits with a diagnosis of PE increased significantly from 2001 to 2010 and this rise can be attributed in large part to the increased availability and use of CT. Most of these patients were admitted with low in-hospital mortality.

Pulmonary thromboembolism in an emergency hospital: Are our patients different?

“…PTE diagnosis represented 0.31% of all hospitalizations during the 2-year studied period, an incidence rate similar to those reported in the United States (between 0.047-0.40%) [7]. Our data is limited to PE patients who were hospitalized, and PTE diagnosis could be more frequent in the emergency department, even though admittance rates reported in the US are around 86% [8].…”

Multicenter Evaluation of the YEARS Criteria in Emergency Department Patients Evaluated for Pulmonary Embolism

“…From a systems and operational standpoint, reducing imaging can reduce cost and length of stay for patients receiving emergency care. In the United States, approximately 1% of the 1.2 million ED visits involve a CTPA . Thus, a 14% reduction in the need for imaging for PE could have a large impact on the public health and the cost of health care.…”

Comparison of the Wells score with the revised Geneva score for assessing suspected pulmonary embolism: a systematic review and meta-analysis

“…Approximately one out of every 400-1500 adult emergency department patients will be diagnosed with PE in the United States [1]. Moreover, the likelihood of having a diagnosis of PE increased significantly per year from 2001 to 2010 among patients with emergency department visit, with the odds ratio (OR) 1.091 (95 % confidence interval (CI) 1.034-1.152) (P = 0.002) for trend, after adjusted for demographic and hospital information [2]. Acute PE is almost always related with poor prognosis.…”