Triaging in pulmonary embolism.

Area of Science:

• Cardiology
• Pulmonology
• Emergency Medicine

Background:

• Pulmonary embolism (PE) risk stratification is crucial for guiding initial therapeutic management.
• PE is categorized into risk groups based on factors influencing early death or complications.
• Accurate risk assessment aids in tailoring treatment strategies and improving patient outcomes.

Purpose of the Study:

• To outline the risk stratification of patients diagnosed with pulmonary embolism.
• To differentiate between high-risk, intermediate-risk, and low-risk PE patient groups.
• To inform therapeutic management decisions based on identified risk levels.

Main Methods:

• Defining high-risk PE by shock or peripheral hypoperfusion signs.
• Assessing intermediate-risk PE in normotensive patients with right ventricular dysfunction or myocardial injury.
• Identifying low-risk PE in normotensive patients without these indicators.

Main Results:

• High-risk PE presents with shock/hypoperfusion, a life-threatening emergency with >25% short-term mortality, requiring inotropes and fibrinolysis.
• Intermediate-risk PE (normotensive, RV dysfunction/myocardial injury) requires close monitoring; thrombolysis role is under investigation.
• Low-risk PE (normotensive, no RV dysfunction/myocardial injury) has low mortality, potentially allowing home treatment.

Conclusions:

• Pulmonary embolism risk stratification effectively categorizes patients into distinct risk groups.
• Therapeutic strategies, including monitoring and thrombolysis, should be guided by PE risk stratification.
• The development of risk scores aids in the clinical assessment and management of pulmonary embolism.