In patients considered to have acute, low-risk pulmonary embolism (PE), a study results indicated that concerning findings on PE-protocol computed tomography (CTPE) imaging may be linked to increased hospitalization rather than use of outpatient facilities. Additionally, CTPE findings in these patients with low-risk PE were not associated with worse short-term clinical outcomes. Study results were reported in JAMA Network Open.
The study was a registry-based analysis of acute PEs diagnosed at the emergency department (ED) of a medical center in the period from October 10, 2016, to December 31, 2019. The PE Severity Index (PESI), with or without biomarker findings, was used to stratify patients with acute PE into high- or low-risk categories. Patients in the low-risk group were additionally categorized by various types of concerning CTPE findings.
Analyses were directed at whether concerning CTPE findings showed associations with treatment and outcomes for these patients with acute, low-risk PE. All-cause mortality at 7 and 30 days was the main outcome of interest in this study.
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There were 817 patients with acute PEs who were included in the study. Use of the PESI score placed 40.5% of patients into the low-risk group and 59.5% into the high-risk group. In the low-risk group, 180 patients had no concerning CTPE findings, while 151 had concerning CTPE findings.
Similar clinical outcomes were generally seen across the low-risk group. The 7-day mortality rate was 0% in patients of the low-risk group, regardless of CTPE findings, compared with 6.8% for the high-risk group.
Among patients in the low-risk group who had concerning CTPE findings, the 30-day mortality rate was 0%, compared with 88 fatalities (18.1%) in the high-risk group by this time point (P <.001).
Patients who were low risk but who had concerning CTPE findings were less often placed into outpatient treatment, compared with low-risk patients who did not have concerning CTPE findings (2.0% versus 7.8%, respectively; P =.01).
In low-risk patients, transthoracic echocardiography was also performed more often in those with concerning CTPE findings (57.6%) than in those without concerning CTPE findings (27.2%; P <.001). Activation of the PE response team for consideration of advanced therapies was more often done with low-risk patients who had concerning CTPE findings (22.5%) than in those without concerning CTPE findings (6.1%; P <.001).
“In summary, ED patients with acute, low-risk PE had similar short-term outcomes irrespective of CTPE results. Nonetheless, specific CTPE findings were associated with increased resource utilization and hospitalization of these patients,” the study investigators wrote in their report.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of disclosures.
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
