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Objectives <p>Pulmonary embolism is a serious condition requiring accurate diagnosis, management, and risk stratification to guide treatment and disposition. While outpatient management for pulmonary embolism may be safe for select patients, its application in the emergency department (ED) setting remains uncertain. This study aimed to evaluate the safety of outpatient management for patients presenting to the ED with pulmonary embolism.</p> Methods <p>This was a health-record review of patients with confirmed pulmonary embolism in 2 large EDs of a tertiary care hospital. Stable patients were discharged by the ED physicians, usually without consultation and patients were seen in a specialized thrombosis clinic within 48&#xa0;h. Anticoagulation follow-up was coordinated through the thrombosis clinic. We reviewed electronic hospital records using a standardized data collection form. The primary outcome was return to the ED within 5&#xa0;days due to early clinical deterioration requiring escalation of treatment. Descriptive statistics are presented.</p> Results <p>Out of the 300 patients initially screened, 253 patients had confirmed pulmonary embolism and were evaluated in this review. Ten were excluded (3 admitted for another reason, 5 were discharged by the consulting service, 1 left against medical advice, 1 died in the ED). Of the 243 patients in the final analysis, 101 patients (41.6%) were discharged and managed as outpatients, whereas 58.4% required hospital admission. The discharged patients were younger (mean age 55.0 vs. 64.9&#xa0;years) and 61.4% received direct-oral anticoagulants. Of these discharged patients, nine (8.9%; 95% CI 4.8–16.1%) returned to the ED within a 5-day period. Five (5.0%) returned due to pulmonary embolism, none suffered clinical deterioration, and none were admitted; of four patients who returned for other reasons (4.0%), none suffered clinical deterioration, and two were admitted.</p> Conclusion <p>Outpatient management of low-risk pulmonary embolism was safe, with no deterioration or escalation of care observed. These findings demonstrate the feasibility of safely discharging low-risk patients by the ED physician with appropriate follow-up, potentially reducing unnecessary hospital admissions.</p>

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Safety of outpatient management of pulmonary embolism diagnosed in the emergency department

  • 期刊论文

  • 发表日期：

    2026年7月25日

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  • Talal Alkhaldi,
  • Nathan Hecht,
  • Michael Y. Woo,
  • Marie-Joe Nemnom,
  • Ian Stiell

摘要

Objectives

Pulmonary embolism is a serious condition requiring accurate diagnosis, management, and risk stratification to guide treatment and disposition. While outpatient management for pulmonary embolism may be safe for select patients, its application in the emergency department (ED) setting remains uncertain. This study aimed to evaluate the safety of outpatient management for patients presenting to the ED with pulmonary embolism.

Methods

This was a health-record review of patients with confirmed pulmonary embolism in 2 large EDs of a tertiary care hospital. Stable patients were discharged by the ED physicians, usually without consultation and patients were seen in a specialized thrombosis clinic within 48 h. Anticoagulation follow-up was coordinated through the thrombosis clinic. We reviewed electronic hospital records using a standardized data collection form. The primary outcome was return to the ED within 5 days due to early clinical deterioration requiring escalation of treatment. Descriptive statistics are presented.

Results

Out of the 300 patients initially screened, 253 patients had confirmed pulmonary embolism and were evaluated in this review. Ten were excluded (3 admitted for another reason, 5 were discharged by the consulting service, 1 left against medical advice, 1 died in the ED). Of the 243 patients in the final analysis, 101 patients (41.6%) were discharged and managed as outpatients, whereas 58.4% required hospital admission. The discharged patients were younger (mean age 55.0 vs. 64.9 years) and 61.4% received direct-oral anticoagulants. Of these discharged patients, nine (8.9%; 95% CI 4.8–16.1%) returned to the ED within a 5-day period. Five (5.0%) returned due to pulmonary embolism, none suffered clinical deterioration, and none were admitted; of four patients who returned for other reasons (4.0%), none suffered clinical deterioration, and two were admitted.

Conclusion

Outpatient management of low-risk pulmonary embolism was safe, with no deterioration or escalation of care observed. These findings demonstrate the feasibility of safely discharging low-risk patients by the ED physician with appropriate follow-up, potentially reducing unnecessary hospital admissions.