Emergency Department Discharge of Pulmonary Embolus Patients

W. Frank Peacock, Craig I. Coleman, Deborah B. Diercks, Samuel Francis, Christopher Kabrhel, Catherine Keay, Jeffrey Kline, Jacob Manteuffel, Peter Wildgoose, Jim Xiang, Adam J. Singer

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Hospitalization for low-risk pulmonary embolism (PE) is common, expensive, and of questionable benefit. Objective: The objective was to determine if low-risk PE patients discharged from the emergency department (ED) on rivaroxaban require fewer hospital days compared to standard of care (SOC). Methods: Multicenter, open-label randomized trial in low-risk PE defined by Hestia criteria. Adult subjects were randomized to early ED discharge on rivaroxaban or SOC. Primary outcome was total number of initial hospital hours, plus hours of hospitalization for bleeding or venous thromboembolism (VTE), 30 days after randomization. A 90-day composite safety endpoint was defined as major bleeding, clinically relevant nonmajor bleeding, and mortality. Results: Of 114 randomized subjects, 51 were early discharge and 63 were SOC. Of 112 (98.2%) receiving at least one dose of study drug, 99 (86.8%) completed the study. Initial hospital LOS was 4.8 hours versus 33.6 hours, with a mean difference of –28.8 hours (95% confidence interval [CI] = –42.55 to –15.12 hours) for early discharge versus SOC, respectively. At 90 days, mean total hospital days (for any reason) were less for early discharge than SOC, 19.2 hours versus 43.2 hours, with a mean difference of 26.4 hours (95% CI = –46.97 to –3.34 hours). At 90 days, there were no bleeding events, recurrent VTE, or deaths. The composite safety endpoint was similar in both groups, with a difference in proportions of 0.005 (95% CI = –0.18 to 0.19). Total costs were $1,496 for early discharge and $4,234 for SOC, with a median difference of $2,496 (95% CI = –$2,999 to –$2,151). Conclusions: Low-risk ED PE patients receiving early discharge on rivaroxaban have similar outcomes to SOC, but fewer total hospital days and lower costs over 30 days.

Original languageEnglish (US)
Pages (from-to)995-1003
Number of pages9
JournalAcademic Emergency Medicine
Volume25
Issue number9
DOIs
StatePublished - Sep 1 2018

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Standard of Care
Embolism
Hospital Emergency Service
Lung
Pulmonary Embolism
Confidence Intervals
Hemorrhage
Venous Thromboembolism
Hospitalization
Safety
Costs and Cost Analysis
Random Allocation
Mortality
Pharmaceutical Preparations
Rivaroxaban

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Frank Peacock, W., Coleman, C. I., Diercks, D. B., Francis, S., Kabrhel, C., Keay, C., ... Singer, A. J. (2018). Emergency Department Discharge of Pulmonary Embolus Patients. Academic Emergency Medicine, 25(9), 995-1003. https://doi.org/10.1111/acem.13451

Emergency Department Discharge of Pulmonary Embolus Patients. / Frank Peacock, W.; Coleman, Craig I.; Diercks, Deborah B.; Francis, Samuel; Kabrhel, Christopher; Keay, Catherine; Kline, Jeffrey; Manteuffel, Jacob; Wildgoose, Peter; Xiang, Jim; Singer, Adam J.

In: Academic Emergency Medicine, Vol. 25, No. 9, 01.09.2018, p. 995-1003.

Research output: Contribution to journalArticle

Frank Peacock, W, Coleman, CI, Diercks, DB, Francis, S, Kabrhel, C, Keay, C, Kline, J, Manteuffel, J, Wildgoose, P, Xiang, J & Singer, AJ 2018, 'Emergency Department Discharge of Pulmonary Embolus Patients', Academic Emergency Medicine, vol. 25, no. 9, pp. 995-1003. https://doi.org/10.1111/acem.13451
Frank Peacock W, Coleman CI, Diercks DB, Francis S, Kabrhel C, Keay C et al. Emergency Department Discharge of Pulmonary Embolus Patients. Academic Emergency Medicine. 2018 Sep 1;25(9):995-1003. https://doi.org/10.1111/acem.13451
Frank Peacock, W. ; Coleman, Craig I. ; Diercks, Deborah B. ; Francis, Samuel ; Kabrhel, Christopher ; Keay, Catherine ; Kline, Jeffrey ; Manteuffel, Jacob ; Wildgoose, Peter ; Xiang, Jim ; Singer, Adam J. / Emergency Department Discharge of Pulmonary Embolus Patients. In: Academic Emergency Medicine. 2018 ; Vol. 25, No. 9. pp. 995-1003.
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abstract = "Background: Hospitalization for low-risk pulmonary embolism (PE) is common, expensive, and of questionable benefit. Objective: The objective was to determine if low-risk PE patients discharged from the emergency department (ED) on rivaroxaban require fewer hospital days compared to standard of care (SOC). Methods: Multicenter, open-label randomized trial in low-risk PE defined by Hestia criteria. Adult subjects were randomized to early ED discharge on rivaroxaban or SOC. Primary outcome was total number of initial hospital hours, plus hours of hospitalization for bleeding or venous thromboembolism (VTE), 30 days after randomization. A 90-day composite safety endpoint was defined as major bleeding, clinically relevant nonmajor bleeding, and mortality. Results: Of 114 randomized subjects, 51 were early discharge and 63 were SOC. Of 112 (98.2{\%}) receiving at least one dose of study drug, 99 (86.8{\%}) completed the study. Initial hospital LOS was 4.8 hours versus 33.6 hours, with a mean difference of –28.8 hours (95{\%} confidence interval [CI] = –42.55 to –15.12 hours) for early discharge versus SOC, respectively. At 90 days, mean total hospital days (for any reason) were less for early discharge than SOC, 19.2 hours versus 43.2 hours, with a mean difference of 26.4 hours (95{\%} CI = –46.97 to –3.34 hours). At 90 days, there were no bleeding events, recurrent VTE, or deaths. The composite safety endpoint was similar in both groups, with a difference in proportions of 0.005 (95{\%} CI = –0.18 to 0.19). Total costs were $1,496 for early discharge and $4,234 for SOC, with a median difference of $2,496 (95{\%} CI = –$2,999 to –$2,151). Conclusions: Low-risk ED PE patients receiving early discharge on rivaroxaban have similar outcomes to SOC, but fewer total hospital days and lower costs over 30 days.",
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AU - Kline, Jeffrey

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