The study also investigated how often emergency physicians activated the PE Response Team, a multi-disciplinary group designed to make rapid, shared decisions on the management of patients with intermediate and high risk PE at U-M Health. "The rate of discharge and home management was about four times lower in low risk patients with concerning CT imaging findings, and they were more likely to have bedside ultrasounds performed in the emergency department and echocardiograms while in the hospital." "Clinical outcomes were similar, but we found plenty of evidence that emergency physicians are managing these patients differently," Greineder said. These patients also rarely required intensive care, and their lengths of stay in the hospital were no different than low-risk patients without "concerning" CT imaging findings. Within a month of coming to the emergency department, 18% of patients with high risk PESI scores died, whereas none of the low-risk patients with concerning CT imaging findings died. These included large and centrally located PEs, blood clots on both sides of the lung, evidence of strain on the heart due to the blockage and associated infarction or death of a region of lung tissue. Using the PESI score, patients were divided into low- and high-risk groups, with the low-risk group further divided based on the presence of concerning CT findings. Researchers assessed data from more than 800 patients at U-M Health diagnosed with acute pulmonary embolism in the adult emergency department between late 2016 and the end of 2019. In our population, if the patient's pulse, rate of breathing, oxygen level and other clinical factors indicated low risk, then 'concerning' CT findings by themselves were not associated with worse clinical outcomes." "In fact, our findings suggest that CT findings alone might not confer as much risk as we thought. "The results of this study are going to come as a surprise to most emergency physicians, who have been taught for years to regard large, centrally located, or 'saddle,' PEs as true medical emergencies," said senior author Colin Greineder, M.D., Ph.D., an assistant professor of emergency medicine and pharmacology at University of Michigan Medical School. Roughly half of the low risk patients had CT imaging features that physicians consider "concerning," and these patients fared just as well in the hospital as those whose CT scans showed no concerning findings. Mayo Clinic 2020.But new Michigan Medicine research, published in JAMA Network Open, finds that some patients with PE, a blood clot in one or more pulmonary arteries, may be hospitalized unnecessarily due to computed tomography (CT) imaging results rather than clinical risk factors.Īpproximately 40% of the patients in the study had low-risk pulmonary embolism, as defined by the Pulmonary Embolism Severity Index, or PESI score. Overview of the treatment of lower extremity deep vein thrombosis (DVT). New York, N.Y.: The McGraw-Hill Companies 2016. In: Current Medical Diagnosis & Treatment 2016. New York, N.Y.: McGraw-Hill Education 2015. In: Harrison's Principles of Internal Medicine. Rochester, Minn.: Mayo Foundation for Medical Education and Research 2012. Preventing blood clots in the veins and lungs.
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