Outcomes Considered Most Important by Emergency Physicians When Determining Disposition of Patients with Pulmonary Embolism
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Outcomes Considered Most Important by Emergency Physicians When Determining Disposition of Patients with Pulmonary Embolism
| Title: | Outcomes Considered Most Important by Emergency Physicians When Determining Disposition of Patients with Pulmonary Embolism |
| Author: |
Sacco, Weston; Hariharan, Praveen; Kabrhel, Christopher; Liu, Shan Woo
Note: Order does not necessarily reflect citation order of authors. |
| Citation: | Kabrhel, Christopher, Weston Sacco, Shan Liu, and Praveen Hariharan. 2010. Outcomes considered most important by emergency physicians when determining disposition of patients with pulmonary embolism. International Journal of Emergency Medicine 3(4): 239-264. |
| Full Text & Related Files: |
3047862.pdf (2.665Mb; PDF) 
|
| Abstract: | Purpose: Clinical decision rules for the disposition of patients with pulmonary embolism (PE) are typically validated against an outcome of 30-day mortality or disease recurrence. There is little justification for this time frame, nor is it clear whether this outcome reflects emergency department (ED) decision making. Aims: To determine which outcomes emergency physicians (EP) consider most relevant to disposition decisions. Methods: Survey of attending EPs in geographically diverse US states using acute PE as the diagnostic framework. Responses required single-answer multiple choice, a numerical percentage, rank-ordered responses, or a five-point Likert scale. We distributed the survey via e-mail to 608 EPs. Results: We received responses from 292 (48%) EPs: 88% board certified, 91% trained in emergency medicine, and 70% work in academics. Respondents reported discharging 1% of patients with PE from the ED, but 21% reported being asked to do so by an admitting service. EPs were more interested in knowing 5-day (in hospital) outcomes [192/265, 72% (95% exact CI=66%–78%)] than 30-day outcomes [39/261, 15% (95% exact CI=11%–20%)] or 90-day outcomes [29/263, 11% (95% exact CI=8%–15%)]. On a Likert scale, 212/241 (88%, 95% exact CI=83%–92%) agreed or strongly agreed that they considered 5-day (in hospital) clinical deterioration when making a decision to admit or discharge a patient from the ED compared to 184/242 (76%, 95% exact CI=70%–81%) and 73/242 (30%, 95% exact CI=24%–36%) for 30 and 90 days, respectively. A wide variety of clinical outcomes beyond death or recurrent PE were considered indicative of clinical deterioration. Conclusions: Five-day (in hospital) outcomes that incorporate a variety of clinical deterioration events are of interest to EPs when determining the disposition of ED patients with PE. Researchers should consider this when developing and validating clinical decision rules. |
| Published Version: | doi:10.1007/s12245-010-0206-8 |
| Other Sources: | http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047862/pdf/ |
| Terms of Use: | This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA |
| Citable link to this page: | http://nrs.harvard.edu/urn-3:HUL.InstRepos:5146969 |
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