Clinical risk assessment in decision making for hospital discharge of patients with pulmonary embolism

Introduction: There are a vast number of studies that analyze the safest possible way of early at-home treatment of patients with pulmonary embolism after diagnosis. Objective: Our study aimed to find out how many patients could be discharged safely and without complications, if using the three validated score systems of the 2019 European Society of Cardiology guideline regarding pulmonary embolism. Method: Throughout our retrospective, quantitative study, we gathered data from the 2015-2018 period before the establishment of the new, 2019 guideline. We assessed patients who had a diagnosis of pulmonary embolism at the emergency room in the given period. With the help of the prognostic score systems, we retrospectively made a risk stratification using the main symptoms and vital parameters. We analyzed the categorical variables with chi-square test. For assessing two continuous variables, we used Pearson's correlation. We defined our level of significance at p<0,05. Results: 374 (199 female and 175 male) patients were enrolled in our study. Our retrospective calculation had the following results: based on the PESI score 151 patients, on the basis of the sPESI 101 patients and according to the Hestia criteria 50 patients could have been discharged, treated at home without complications and increasing the mortality. The negative predictive value (PESI: 98%, sPESI: 100%, Hestia: 100% with CI: 95%) and sensitivity (PESI: 91%, sPESI: 100%, Hestia: 100%) of the three prognostic scores showed applicable efficiency. Conclusion: We concluded that all three prognostic criteria can be used safely taking the local clinical experience and preference into consideration, aiming at early discharge. Adapting them nationally could decrease hospital load.