Author + information
- Received February 12, 2010
- Revision received May 3, 2010
- Accepted May 17, 2010
- Published online February 8, 2011.
- Charles V. Pollack, MD⁎,
- Donald Schreiber, MD†,
- Samuel Z. Goldhaber, MD‡,
- David Slattery, MD§,
- John Fanikos, RPh, MBA∥,
- Brian J. O'Neil, MD¶,
- James R. Thompson, MD#,
- Brian Hiestand, MD⁎⁎,
- Beau A. Briese, MA, MD††,
- Robert C. Pendleton, MD‡‡,
- Chadwick D. Miller, MD, MS§§ and
- Jeffrey A. Kline, MD∥∥,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Jeffrey A. Kline, Department of Emergency Medicine, Carolinas Medical Center, PO Box 32861, 1000 Blythe Boulevard, Charlotte, North Carolina 28232
Objectives In a large U.S. sample, this study measured the presentation features, testing, treatment strategies, and outcomes of patients diagnosed with pulmonary embolism (PE) in the emergency department (ED).
Background No data have quantified the demographics, clinical features, management, and outcomes of outpatients diagnosed with PE in the ED in a large, multicenter U.S. study.
Methods Patients of any hemodynamic status were enrolled from the ED after confirmed acute PE or with a high clinical suspicion prompting anticoagulation before imaging for PE. Exclusions were inability to provide informed consent (where required) or unavailability for follow-up.
Results A total of 1,880 patients with confirmed acute PE were enrolled from 22 U.S. EDs. Diagnosis of PE was based upon positive results of computerized tomographic pulmonary angiogram in most cases (n = 1,654 [88%]). Patients represented both sexes equally, and racial and ethnic composition paralleled the overall U.S. ED population. Most (79%) patients with PE were employed, and one-third were older than age 65 years. The mortality rate directly attributed to PE was 20 in 1,880 (1%; 95% confidence interval [CI]: 0% to 1.6%). Mortality from hemorrhage was 0.2%, and the all-cause 30-day mortality rate was 5.4% (95% CI: 4.4% to 6.6%). Only 3 of 20 patients with major PE that ultimately proved fatal had systemic anticoagulation initiated before diagnostic confirmation, and another 3 of these 20 received a fibrinolytic agent.
Conclusions Patients diagnosed with acute PE in U.S. EDs have high functional status, and their mortality rate is low. These registry data suggest that appropriate initial medical management of ED patients with severe PE with anticoagulation is poorly standardized and indicate a need for research to determine the appropriate threshold for empiric treatment when PE is suspected before diagnostic confirmation.
Funding was provided by GlaxoSmithKline. Dr. Pollack has served as a consultant and a speaker for Sanofi-Aventis and has received research funding from Sanofi-Aventis and GlaxoSmithKline. Dr. Goldhaber is a consultant for Sanofi-Aventis, Eisai, Bristol-Myers Squibb, Boehringer Ingelheim, and Medscape. Dr. Fanikos has served as a consultant to Sanofi-Aventis and GlaxoSmithKline. Dr. O'Neil is on the Speakers Bureau for GlaxoSmithKline, Sanofi-Aventis, and Bristol-Myers Squibb; and is on the advisory board for Heartscape Technologies. Dr. Hiestand has received research funding from Medtronic Inc., Biosite Inc., Inovise Medical Inc., Heartscape International, Nanosphere Inc., Mitsubishi Medience, and The Medicines Company; and has a medical writing consulting relationship with newMentor Inc. Dr. Pendleton is on the Speakers Bureau for Sanofi-Aventis; and has received research support from Pfizer, Bristol-Myers Squibb, and Boehringer Ingelheim. Dr. Miller has received research support from Siemens, Breathquant Medical LLC, Biosite, Schering-Plough, Johnson and Johnson/Scios Inc., and PDL Biopharma and served as a speaker for Genentech and at CME events sponsored by Sanofi-Aventis and Schering-Plough and as a consultant to Breathquant Medical LLC, the Medicines Company, and Molecular Insight. Dr. Kline has received funding from the National Institutes of Health and has been a clinical investigator on a clinical trial sponsored by Octapharma (octaplex) and a clinical trial sponsored by Pfizer (apixaban) and a primary investigator on an investigator-initiated clinical trial funded by Genentech; he has stock ownership in CP Diagnostics, a privately held LLC in North Carolina. All other authors have reported that they have no relationships to disclose.
- Received February 12, 2010.
- Revision received May 3, 2010.
- Accepted May 17, 2010.
- American College of Cardiology Foundation