P226 Managing suspected pulmonary embolism in an ambulatory setting: the Leicester experience

Abstract

Introduction: Suspected Pulmonary Embolism (PE) is a significantcause of admission to hospital. The objective of this study was toestablish the feasibility and safety of managing suspected andproven PE in an out-patient setting. Methods: Criteria for low risk patients with suspected PE suitable fortreatment in an ambulatory setting were established based onmodified Pulmonary Embolism Severity Score (PESI) criteria.Patients deemed low risk were referred to a nurse-led clinic. Clinicalpre-test probability of PE was recorded for all patients and thosewith a low/intermediate probability had D-dimer testing. Patientswith a high pre-test probability or D-dimer=0.5 (mu)g/ml had radiological investigations. Data were collected prospectively. Missinginformation was completed from pathology, imaging systems andcase-note review. Results: 362 patients (Median age 46, Female 70%) with suspectedPE were referred to the ambulatory clinic in 12 months from June2010. 269 (74%) patients presented with chest pain. 145 patients(40%) had a negative D-dimer and were discharged. 210 patients(58%) had subsequent imaging in the form of 65 (31%) VQ scan, 138(66%) CT scan, 7 (3%) both. Median time to imaging was 1 day(range 0-5 days). 34 patients were diagnosed with PE (9%). 11patients (3%) were admitted, of which 5 (45%) were due to rightheart strain. Likelihood of PE correlated strongly to clinical probability(low 2%, intermediate 14%, high 42%). One patient with anegative D-Dimer and intermediate clinical probability was diagnosedwith PE. 294 (81%) patients were discharged with no followup,28 (8%) patients were followed-up by consultant care. Onepatient admitted as they did not meet criteria for ambulatory care(tachycardia) had a cardiorespiratory arrest as an inpatient due tomassive PE but was successfully resuscitated. To date three patientshave (0.8%) died since attending the clinic, no death was related toPE. Savings to PCTs were estimated at (pounds)120 000 over 12 months.Conclusion Selected patients with suspected and proven PE may bemanaged safely in an ambulatory PE clinic setting resulting insignificant savings to the healthcare community