Outpatient Management of Patients With Pulmonary Embolism
Authors: Pierre-Marie Roy, Guy Meyer, Olivier Sanchez, Menno Huisman
Journal: Annals of Internal Medicine (2019)

Letters6 August 2019Outpatient Management of Patients With Pulmonary EmbolismPierre-Marie Roy, MD, PhD, Guy Meyer, Olivier Sanchez, MD, PhD, and Menno Huisman, MD, PhDPierre-Marie Roy, MD, PhDCentre Hospitalier Universitaire d'Angers, Angers, France (P.R.)Search for more papers by this author, Guy MeyerHôspital Européen Georges Pompidou, Paris, France (G.M., O.S.)Search for more papers by this author, Olivier Sanchez, MD, PhDHôspital Européen Georges Pompidou, Paris, France (G.M., O.S.)Search for more papers by this author, and Menno Huisman, MD, PhDLeiden University Medical Center Leiden, the Netherlands (M.H.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0206 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We read Vinson and colleagues' controlled trial on outpatient management of patients with acute pulmonary embolism (PE) with interest (1). Using a computerized clinical decision-support system based on the PE Severity Index (PESI) score and pragmatic exclusion criteria, the authors performed a multifaceted intervention to help identify patients who can safely forgo hospitalization. In the intervention group, they significantly increased outpatient management from 27.7% to 41.1% in patients with low-risk PESI scores. They also observed that 19.3% of patients with a PESI class of III to V were safely managed at home. The computerized clinical decision-support system ...References1. Vinson DR, Mark DG, Chettipally UK, et al; eSPEED Investigators of the KP CREST Network. Increasing safe outpatient management of emergency department patients with pulmonary embolism. A controlled pragmatic trial. Ann Intern Med. 2018;169:855-65. [PMID: 30422263]. doi:10.7326/M18-1206 LinkGoogle Scholar2. Aujesky D, Obrosky DS, Stone RA, et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med. 2005;172:1041-6. [PMID: 16020800] CrossrefMedlineGoogle Scholar3. Roy PM, Corsi DJ, Carrier M, et al. Net clinical benefit of hospitalization versus outpatient management of patients with acute pulmonary embolism. J Thromb Haemost. 2017;15:685-94. [PMID: 28106343] doi:10.1111/jth.13629 CrossrefMedlineGoogle Scholar4. Zondag W, Mos IC, Creemers-Schild D, et al; Hestia Study Investigators. Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study. J Thromb Haemost. 2011;9:1500-7. [PMID: 21645235] doi:10.1111/j.1538-7836.2011.04388.x CrossrefMedlineGoogle Scholar5. den Exter PL, Zondag W, Klok FA, et al; Vesta Study Investigators. Efficacy and safety of outpatient treatment based on the hestia clinical decision rule with or without N-terminal pro-brain natriuretic peptide testing in patients with acute pulmonary embolism. A randomized clinical trial. Am J Respir Crit Care Med. 2016;194:998-1006. [PMID: 27030891] CrossrefMedlineGoogle Scholar6. Zondag W, den Exter PL, Crobach MJ, et al; Hestia Study Investigators. Comparison of two methods for selection of out of hospital treatment in patients with acute pulmonary embolism. Thromb Haemost. 2013;109:47-52. [PMID: 23138355] doi:10.1160/TH12-07-0466 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Centre Hospitalier Universitaire d'Angers, Angers, France (P.R.)Hôspital Européen Georges Pompidou, Paris, France (G.M., O.S.)Leiden University Medical Center Leiden, the Netherlands (M.H.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0206. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIncreasing Safe Outpatient Management of Emergency Department Patients With Pulmonary Embolism David R. Vinson , Dustin G. Mark , Uli K. Chettipally , Jie Huang , Adina S. Rauchwerger , Mary E. Reed , James S. Lin , Mamata V. Kene , David H. Wang , Dana R. Sax , Tamara S. Pleshakov , Ian D. McLachlan , Cyrus K. Yamin , Andrew R. Elms , Hilary R. Iskin , Ridhima Vemula , Donald M. Yealy , Dustin W. Ballard , and Outpatient Management of Patients With Pulmonary Embolism James F.J. Green and Vinodkumar Patil Outpatient Management of Patients With Pulmonary Embolism David R. Vinson , Dustin G. Mark , and Dustin W. Ballard Metrics 6 August 2019Volume 171, Issue 3Page: 227KeywordsClinical decision support systemsComputersComputing systemsDisclosureHospitalizationsMortalityOutpatientsPulmonary embolismRetrospective studiesSafety ePublished: 6 August 2019 Issue Published: 6 August 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...