Unsuspected pulmonary embolism in observation unit patients

Area of Science:

• Emergency Medicine
• Cardiology
• Pulmonology

Background:

• Emergency department (ED) observation units frequently manage patients with cardiopulmonary symptoms.
• Diagnostic evaluation for pulmonary embolism (PE) is not always performed in these observation settings.
• The role of observation units in diagnosing PE remains understudied.

Purpose of the Study:

• To investigate the incidence of unsuspected pulmonary embolism (PE) in emergency department observation unit patients.
• To evaluate the diagnostic yield and outcomes of PE evaluation within observation units.

Main Methods:

• Retrospective chart review of emergency department (ED) patients diagnosed with PE.
• Identification of patients with PE who were placed in observation units.
• Analysis of diagnostic events, admission status, and in-hospital outcomes for PE patients in observation.

Main Results:

• Thirteen of 190 pulmonary embolism (PE) patients were initially placed in observation units.
• A confirmed PE rate of 0.12% was observed in the general observation unit population.
• Five cases (0.08% rate) were classified as unsuspected PE prior to observation assignment.

Conclusions:

• A small but significant incidence of unsuspected pulmonary embolism (PE) exists in observation unit patients.
• High admission rates and prolonged stays for PE patients suggest observation is often inappropriate.
• A targeted screening strategy for PE in observation units may be warranted due to low incidence.