Emergency Department diagnosis of pulmonary embolism is associated with significantly reduced mortality: a linked...

We characterized patients admitted via ED with a principal hospital discharge diagnosis of pulmonary embolism (PE) and compared mortality of those diagnosed in the ED with those diagnosed after admission.

Patients with a hospital discharge diagnosis ICD 10 I26 presenting to the ED in Perth, Western Australia between 1 July 2000 and 30 December 2006 had records from the Emergency Department Information System linked to the Western Australian Hospital Morbidity Data System and the death registry.

Of 2250 patients (mean age 60.4), 1227 (54.5%) were female. Of 1931 patients with an ED diagnosis recorded, 1207 (62.5%) were diagnosed with PE in ED. Of these, 383 (17.0%) had presented to an ED within 28 days previously, 142 (37.1%) with either chest pain or breathing problems, with 207 (54.0%) admitted but not receiving a principal hospital discharge diagnosis of PE. There were 127 (5.6%) in-hospital deaths. Controlling for age and comorbidity with logistic regression, patients diagnosed with PE in ED were less likely to die in hospital, within 7 and 30 days of ED arrival, than those diagnosed after admission (adjusted OR 0.31, 95% CI 0.20-0.47; adjusted OR 0.32, 95% CI 0.19-0.53; adjusted OR 0.30, 95% CI 0.20-0.44; respectively).

Making the diagnosis of PE in ED was associated with a substantial survival advantage that persisted after hospital discharge.