Concerning CT findings tied to increased hospitalization and resource utilization in low-risk PE patients: JAMA

O'Hare and the team aimed to evaluate the association between concerning Computed Tomography (CT) imaging findings and treatment outcomes in patients with acute, low-risk pulmonary embolism who presented to the emergency department (ED).

A cohort study using a registry of all acute PE cases diagnosed in the adult ED of an academic medical centre from October 10, 2016, to December 31, 2019. The study included 817 patients with acute PEs, with a median age of 58. The patients were divided into high-risk and low-risk groups based on the PE Severity Index (PESI) class and biomarker results. The low-risk group was further divided based on concerning CT imaging findings. The primary outcome was all-cause mortality at 7 and 30 days, and secondary outcomes included hospitalization, length of stay, need for intensive care, use of echocardiography and bedside ultrasonography, and activation of the PE response team (PERT).

The study highlights:

• Among them, 40.5% were classified as low risk, and 59.5% as high risk.
• There were no 30-day deaths in the low-risk group concerning CT findings, compared to 2.2% in the low-risk group without CT findings and 18.1% in the high-risk group.
• Low-risk patients with concerning CT findings were less frequently discharged from the ED, had more routine echocardiography, and had higher activation of the PE response team.

Thus, the study suggested that concerning CT imaging findings may be a significant barrier to outpatient treatment among patients with otherwise low-risk acute PE. ED patients with acute, low-risk PE had similar short-term outcomes irrespective of CTPE results.

The study gave insights into the appropriate management and treatment of patients with low-risk PE based on individualized risk assessment rather than relying solely on CT findings. ED patients with acute, low-risk PE had similar short-term outcomes irrespective of CTPE results.

Reference

O’Hare C, Grace KA, Schaeffer WJ, et al. Adverse Clinical Outcomes Among Patients With Acute Low-risk Pulmonary Embolism and Concerning Computed Tomography Imaging Findings. JAMA Netw Open. 2023;6(5):e2311455.

Doi:10.1001/jamanetworkopen.2023.11455