Bohdan Baralo, MD
Resident
Mercy Fitzgerald Hospital
Darby, Pennsylvania
Disclosure information not submitted.
Vihitha Thota, MD
Internal Medicine Resident
Mercy Catholic Medical Center, Pennsylvania, United States
Disclosure information not submitted.
Ruqqiya Mustaqeem, MD
Resident
Mercy Catholic Medical Center, United States
Disclosure information not submitted.
Keerthy Joseph, DO
Resident
Mercy Catholic Medical Center, United States
Disclosure information not submitted.
Aliza Khanam, MD
Chief Resident
Mercy Catholic Medical Center, United States
Disclosure information not submitted.
Navyamani Kagita, MD
Resident
Mercy Catholic Medical Center, United States
Disclosure information not submitted.
O'Neil Chaudhry, MD
Resident
Mercy Catholic Medical Center, United States
Disclosure information not submitted.
Rajesh Thirumaran, MD
Attending Physician
Mercy Catholic Medical Center, United States
Disclosure information not submitted.
Yu Yu Thar, MD
Attending Physician
Mercy Catholic Medical Center, United States
Disclosure information not submitted.
Title: Utilization of the PESI Score in the Community Hospital Setting
Introduction: The pulmonary embolism severity index (PESI) score is a well-known and validated clinical tool, utilized to predict 30-day mortality in patients with pulmonary embolism (PE). It is used to identify low-risk individuals (PESI < =85) who can be safely started on novel oral anticoagulation agents (NOAC) and discharged from the Emergency Department (ED). After calculating the PESI score in all patients admitted for PE within a 3-year period at a community hospital, this study first estimated the fraction of low-risk patients who ended up getting admitted. Additionally, this study compared the prevalence of right heart strain (RHS), incidence of bleeding events, and mortality rates between the low-risk and high-risk (PESI >85) cohorts.
Methods: This study is a retrospective chart review of patients admitted with a primary diagnosis of PE to Mercy Fitzgerald Hospital from January 2018 to March 2021. The Fisher test was used to compare odds ratios (OR) of RHS on initial CT angiogram of the chest, bleeding events after initiation of the anticoagulation (drop in hemoglobin > 2 g/dL, positive hemoccult status, episodes of overt bleeding), and death rates between low-risk and high-risk groups. PRISM statistical software was used for statistical analysis.
Results: 211 patients were included in this study. 102 (48.3%) patients were categorized as low-risk and 109 (51.7%) as high-risk. RHS was present in 16 patients of the low-risk group (2 of which had saddle PE) versus 41 in the high-risk group (OR 0.39, CI [0.2-0.76], p 0.005). Bleeding after initiation of anticoagulation was observed in 2 patients in the low-risk versus 5 patients in the high-risk group (OR 0.42, CI [0.08-2], p 0.45). None of the patients in the low-risk group died during the admission compared to 6 patients from the high-risk group (OR non reported, CI [0-0.74], p 0.03).
Conclusions: When factoring in patients with RHS on initial imaging, 40.7% of the patients hospitalized for PE potentially could have been discharged safely for outpatient management based on this study. The patients who were identified as high risk had a higher occurrence of RHS and had significantly higher mortality compared to the low-risk group. The rate of bleeding events after initiation of anticoagulation among both groups was not statistically different.