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Managing Pulmonary Embolism in the ED

Managing Pulmonary Embolism in the ED

Venous thromboembolism (VTE), which includes DVT and pulmonary embolism (PE), is the third leading cause of cardiovascular death among Americans and is especially fatal if these events go undiagnosed and are not treated promptly. PE is most frequently diagnosed in the ED and is associated with 14- and 30-day mortality rates of about 10% and 20%, respectively. Research has shown that a prompt diagnosis of acute PE—within 48 hours of ED arrival—is associated with improved outcomes. Factors Associated with Delays in PE Diagnosis My colleagues and I previously reported that administra­tion of anticoagulants within 24 hours of ED arrival is as­sociated with reduced mortality. Current guidelines from the American College of Chest Physicians recommend that anticoagulation be initiated even before a confirmed diag­nosis, when the probability of PE is believed to be high. However, studies have indicated that there is potential for significant delays from the time of symptom onset to PE diagnosis in the ED. A prompt diagnosis of acute PE—within 48 hours of ED arrival—is associated with improved outcomes. In an effort to better understand the factors associated with timing of a PE diagnosis in the ED, my colleagues and I conducted a review that was published in the January 2012 Journal of Emergency Medicine. Following univariate and multivariate analyses, we found that the following factors appeared to be associated with delays in PE diagnoses of more than 12 hours: Age older than 65. Concurrent cardiovascular disease (CVD). Morbid obesity (BMI >40 kg/m2). A history of recent immobility (eg, recent surgery) and pre­sentation to the ED with tachycardia were factors associ­ated with a relatively early diagnosis of...
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