Presyncope Is Associated with Intensive Care Unit Admission in Emergency Department Patients with Acute Pulmonary Embolism.
David R. Vinson,Darcy C. Engelhart,Disha Bahl,Alisha A Othieno,Ashley S Abraham,Jie Huang,Mary E. Reed,William P Swanson,William P Swanson,Victoria A Clague,Dale M Cotton,William C. Krauss,Dustin G. Mark,Dustin G. Mark +13 more
Reads0
Chats0
TLDR
Clinicians evaluating patients with acute PE may benefit from including presyncope in their calculus of risk assessment and site-of-care decision-making, as it appears to carry similar strength of association with ICU admission as syncope in ED patients with chronic PE.Abstract:
Introduction: Syncope is common among emergency department (ED) patients with acute pulmonary embolism (PE) and indicates a higher acuity and worse prognosis than in patients without syncope. Whether presyncope carries the same prognostic implications has not been established. We compared incidence of intensive care unit (ICU) admission in three groups of ED PE patients: those with presyncope; syncope; and neither.Methods: This retrospective cohort study included all adults with acute, objectively confirmed PE in 21 community EDs from January 2013–April 2015. We combined electronic health record extraction with manual chart abstraction. We used chi-square test for univariate comparisons and performed multivariate analysis to evaluate associations between presyncope or syncope and ICU admission from the ED, reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI).Results: Among 2996 PE patients, 82 (2.7%) had presyncope and 109 (3.6%) had syncope. ICU admission was similar between groups (presyncope 18.3% vs syncope 25.7%) and different than their non-syncope counterparts (either 22.5% vs neither 4.7%; p<0.0001). On multivariate analysis, both presyncope and syncope were independently associated with ICU admission, controlling for demographics, higher-risk PE Severity Index (PESI) class, ventilatory support, proximal clot location, and submassive and massive PE classification: presyncope, aOR 2.79 (95% CI, 1.40, 5.56); syncope, aOR 4.44 (95% CI 2.52, 7.80). These associations were only minimally affected when excluding massive PE from the model. There was no significant interaction between either syncope or presyncope and PESI, submassive or massive classification in predicting ICU admission.Conclusion: Presyncope appears to carry similar strength of association with ICU admission as syncope in ED patients with acute PE. If this is confirmed, clinicians evaluating patients with acute PE may benefit from including presyncope in their calculus of risk assessment and site-of-care decision-making.read more
Citations
More filters
Journal ArticleDOI
Management and Outcomes of Adults Diagnosed with Acute Pulmonary Embolism in Primary Care: Community-Based Retrospective Cohort Study
David R. Vinson,Erik R. Hofmann,Elizabeth J. Johnson,Suresh Rangarajan,Jie Huang,Dayna J Isaacs,Judy Shan,Karen L. Wallace,Adina S. Rauchwerger,Mary E. Reed,Dustin G. Mark +10 more
TL;DR: In this article , the authors describe 30-day outcomes stratified by initial site-of-care decisions for acute pulmonary embolism patients in a large, diverse community-based US health system (2013-2019).
Journal ArticleDOI
Development and validation of a prognostic tool: Pulmonary embolism short-term clinical outcomes risk estimation (PE-SCORE)
Anthony J. Weekes,Jaron D Raper,Kathryn Lupez,Alyssa M Thomas,Carly A Cox,Dasia Esener,Jeremy S. Boyd,Jason T. Nomura,Jillian Davison,Patrick Ockerse,Stephen Leech,Jakea Johnson,Eric Abrams,Kathleen A Murphy,Christopher Kelly,H. James Norton +15 more
TL;DR: In this article, the authors developed and validated a prognostic model for clinical deterioration or death within days of pulmonary embolism (PE) diagnosis using point-of-care criteria, including laboratory and imaging right ventricle (RV) assessments.
Journal ArticleDOI
Hospitalization Is Less Common in Ambulatory Patients With Acute Pulmonary Embolism Diagnosed Before Emergency Department Referral Than After Arrival.
TL;DR: Patients with acute pulmonary embolism may undergo diagnostic pulmonary imaging as an outpatient before referral to the ED for definitive management, but this population has not been well characterized.
References
More filters
Journal ArticleDOI
Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report
Clive Kearon,Elie A. Akl,Elie A. Akl,Joseph Ornelas,Allen J. Blaivas,David Jiménez,Henri Bounameaux,Menno V. Huisman,Christopher S. King,Timothy A. Morris,Namita Sood,Scott M. Stevens,Janine R.E. Vintch,Philip S. Wells,Scott C. Woller,Lisa K. Moores +15 more
TL;DR: Recommendations on 12 topics that were in the 9th edition of these guidelines are updated, and 3 new topics are addressed.
Journal ArticleDOI
Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients: Definitions of major bleeding in clinical studies
S. Schulman,C. Kearon +1 more
TL;DR: A definition of major bleeding in non‐surgical patients was developed that should be applicable to studies with all agents that interfere with hemostasis, including anticoagulants, platelet function inhibitors and fibrinolytic drugs.
Journal ArticleDOI
Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients.
Sam Schulman,U. Angerås,David Bergqvist,Bengt I. Eriksson,Michael R. Lassen,William D. Fisher +5 more
TL;DR: A definition of major bleeding that should be applicable to all agents that interfere with hemostasis is developed and is to seek approval from the regulatory authorities to enhance its incorporation into future clinical trial protocols.
Journal ArticleDOI
2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS)
Stavros Konstantinides,Guy Meyer,Cecilia Becattini,Héctor Bueno,Geert-Jan Geersing,Veli-Pekka Harjola,Menno V. Huisman,Marc Humbert,Catriona Jennings,David Jiménez,Nils Kucher,Irene M. Lang,Mareike Lankeit,Roberto Lorusso,Lucia Mazzolai,Nicolas Meneveau,Fionnuala Ní Áinle,Paolo Prandoni,Piotr Pruszczyk,Marc Philip Righini,Adam Torbicki,Eric Van Belle,José Luis Zamorano +22 more
TL;DR: Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition.
Journal ArticleDOI
Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension A Scientific Statement From the American Heart Association
Michael R. Jaff,M. Sean McMurtry,Stephen L. Archer,Mary Cushman,Neil A. Goldenberg,Samuel Z. Goldhaber,J. Stephen Jenkins,Jeffrey A. Kline,Andrew Michaels,Patricia A. Thistlethwaite,Suresh Vedantham,R. James White,Brenda K. Zierler +12 more
TL;DR: In this paper, the authors address the management of massive and submassive pulmonary embolisms (PE), iliofemoral deep vein thrombosis (IFDVT), and chronic thromboembolic pulmonary hypertension (CTEPH).