The following is a summary of “Bilateral Emboli and Highest Heart Rate Predict Hospitalisation of Emergency Department Patients With Acute, Low-Risk Pulmonary Embolism,” published in the September 2023 issue of Emergency Medicine by Casey, et al.

Despite being considered low risk by clinical decision guidelines, some patients with acute pulmonary embolism (PE) will experience unfavorable clinical outcomes. It is unknown how emergency physicians decide which low-risk patients must be admitted to the hospital. Researchers expected that patients classified as low risk by the PE Severity Index would be more likely to be hospitalized if their HR was higher or had a higher embolic burden. This retrospective cohort analysis included 461 adult ED patients with a PE Severity Index score 86. 

Primary risks included having a high ED HR, an embolus closer to the heart (proximal versus distal), and a bilateral versus unilateral PE. Hospitalization was the primary measure of success. Most (57.5%) of the 461 individuals who met inclusion criteria were hospitalized, 2 died within 30 days, and 142 were at increased risk according to additional criteria (Hestia criteria or biochemical/radiographic right ventricular dysfunction). The highest observed ED HR 110 vs HR 90 bpm (adjusted odds ratio [aOR] 3.11; 95% CI 1.07 to 9.57), the highest ED HR 90 to 109 bpm (aOR 2.03; 95% CI 1.18-3.50), and bilateral PE (aOR 1.92; 95% CI 1.13 to 3.27), were all factors associated with an increased likelihood of admission. 

Hospitalization rates were similar regardless of embolus site (aOR 1.19; 95% CI 0.71 to 2.00), suggesting that proximal emboli were not a contributing factor. Most people with PE were admitted to the hospital, and many had obvious risk factors that the PE Severity Index missed. Hospitalization was related to a heart rate (HR) in the emergency department (ED) of 90 or more beats per minute and bilateral PE presence.

Source: sciencedirect.com/science/article/abs/pii/S0196064423001233