Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: Initial report of EMPEROR (multicenter emergency medicine pulmonary embolism in the real world registry)

Charles V. Pollack, Donald Schreiber, Samuel Z. Goldhaber, David Slattery, John Fanikos, Brian J. O'Neil, James R. Thompson, Brian Hiestand, Beau A. Briese, Robert C. Pendleton, Chadwick D. Miller, Jeffrey Kline

Research output: Contribution to journalArticle

217 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)700-706
Number of pages7
JournalJournal of the American College of Cardiology
Volume57
Issue number6
DOIs
StatePublished - Feb 8 2011
Externally publishedYes

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Emergency Medicine
Pulmonary Embolism
Registries
Hospital Emergency Service
Mortality
Confidence Intervals
Fibrinolytic Agents
Informed Consent
Multicenter Studies
Angiography
Outpatients
Hemodynamics
Demography

Keywords

  • anticoagulation
  • epidemiology
  • fibrinolysis
  • pulmonary embolism
  • venous thromboembolism

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department : Initial report of EMPEROR (multicenter emergency medicine pulmonary embolism in the real world registry). / Pollack, Charles V.; Schreiber, Donald; Goldhaber, Samuel Z.; Slattery, David; Fanikos, John; O'Neil, Brian J.; Thompson, James R.; Hiestand, Brian; Briese, Beau A.; Pendleton, Robert C.; Miller, Chadwick D.; Kline, Jeffrey.

In: Journal of the American College of Cardiology, Vol. 57, No. 6, 08.02.2011, p. 700-706.

Research output: Contribution to journalArticle

Pollack, Charles V. ; Schreiber, Donald ; Goldhaber, Samuel Z. ; Slattery, David ; Fanikos, John ; O'Neil, Brian J. ; Thompson, James R. ; Hiestand, Brian ; Briese, Beau A. ; Pendleton, Robert C. ; Miller, Chadwick D. ; Kline, Jeffrey. / Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department : Initial report of EMPEROR (multicenter emergency medicine pulmonary embolism in the real world registry). In: Journal of the American College of Cardiology. 2011 ; Vol. 57, No. 6. pp. 700-706.
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abstract = "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.",
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T2 - Initial report of EMPEROR (multicenter emergency medicine pulmonary embolism in the real world registry)

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AU - Schreiber, Donald

AU - Goldhaber, Samuel Z.

AU - Slattery, David

AU - Fanikos, John

AU - O'Neil, Brian J.

AU - Thompson, James R.

AU - Hiestand, Brian

AU - Briese, Beau A.

AU - Pendleton, Robert C.

AU - Miller, Chadwick D.

AU - Kline, Jeffrey

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KW - epidemiology

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KW - venous thromboembolism

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