Kevin Jones, MD, MPH
Physician
University of Maryland R Adams Cowley Shock Trauma Center, United States
Disclosure information not submitted.
James Gerding, PA-C
Physician Assistant
University of Maryland Nedical Center, United States
Disclosure information not submitted.
Stephanie Cardona, DO
Physician
University of Maryland, United States
Disclosure information not submitted.
Taylor Miller, MD
Resident
University of Maryland Medical System
Baltimore, MD
Disclosure information not submitted.
Rafael Cires-Drouet, MD FSVM RPVI
Assistant Professor
University of Maryland School of Medicine, United States
Disclosure information not submitted.
Kristopher Deatrick, MD
Assistant Professor, Assistant Chief Congenital Heart Program
University of Maryland School of Medicine
Baltimore, Maryland, United States
Disclosure information not submitted.
Shahab Toursavadkohi, MD
Associate Professor
University of Maryland Medical College, United States
Disclosure information not submitted.
Emily Esposito, DO
Attending Physician
University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center, United States
Disclosure information not submitted.
William Teeter, MD
Physician
University of Maryland School of Medicine, United States
Disclosure information not submitted.
Elizabeth Powell, MD
Assistant Professor of Emergency Medicine
University of Maryland School of Medicine, United States
Disclosure information not submitted.
Rishi Kundi, MD
Assistant Professor
University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center, United States
Disclosure information not submitted.
Ashley Menne, MD, RDCS
MD
U of Maryland Medical Cntr, R. Adams Cowley Shock Trauma Cntr, United States
Disclosure information not submitted.
Jeffrey Rea, MD
MD
R Adams Cowley Shock Trauma Center, United States
Disclosure information not submitted.
Kim Boswell, MD (she/her/hers)
University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center
Baltimore, MD
Disclosure information not submitted.
Quincy Tran, MD, PhD, FCCM
Associate Professor
University of Maryland Medical Center
Baltimore, MD, United States
Disclosure information not submitted.
Daniel Haase, MD, (he/him/his)
Associate Professor of Emergency Medicine and Surgery
R. Adams Cowley Shock Trauma Center
Baltimore, MD
Disclosure information not submitted.
Title: We Can't Take Them All: Triage of Pulmonary Embolism Transfer Requests to a Regional PERT Center
Introduction: Massive and Sub-Massive Pulmonary Emboli (PE) may benefit from advanced therapies (AT) in order to prevent cardiovascular collapse or CTEPH. Our institution established a regional Pulmonary Embolism Response Team (PERT) to facilitate access to multidisciplinary care and/or AT. The Bova score was utilized to triage consults. Massive PE, Bova Grade 3, and Bova Grade 2 patients with elevated lactate or organ dysfunction were accepted in transfer to our Critical Care Resuscitation Unit, others were advised to admit locally with a referral to our vascular medicine clinic. We provide a descriptive analysis of our PERT triage process.
Methods: This is a single-center retrospective study of PERT transfer requests between 1/2019-6/2021. We included adult patients with confirmed or suspected PE. Data was abstracted from prospectively collected consult records and from the patient's medical records.
Results: PERT received 532 consults between 1/2019 - 6/2021. Mean age was 61 (+/-15) yrs., gender was evenly split between males (227) and females (226). 11% (61) had massive PE, 19%(100) Bova Grade 3, 36%(189) Bova Grade 2, 20%(108) Bova Grade 1, and 10%(52) had PE without cardiac compromise. A total of 183 patients were accepted for transfer, and 143 were transferred. 57%(85) had a massive or Bova Grade 3 PE; of those who did not, 7%(10) were transferred for a clot in transit. Of transferred patients, 39%(57) underwent AT; 14%(21) VA-ECMO, 8%(12) surgical thrombectomy, 5%(7) catheter-directed TPA, 2%(3) suction embolectomy, and 18%(27) systemic TPA. 77%(24) of patients who presented with massive PE required AT. Excluding patients with clot in transit, no patients with Bova Grade < 2 required AT. 23%(12) of patients with Bova Grade 3 and 34%(14) with Bova Grade 2 received AT. 33%(3) of patients with clot in transit underwent thrombectomy; 9 of these 10 patients had Bova grades < 3. 95%(138) of transferred patients survived to discharge; of those who did not, 50% presented with massive PE.
Conclusions: Use of the Bova score in triage stratification facilitates selection of patients for transfer who may benefit from AT available at regional referral centers. Research is ongoing to ensure that our system does not result in excessive under-triage of patients who may benefit from transfer and/or advanced interventions.