Observation management of pulmonary embolism and agreement with claims-based and clinical risk stratification criteria in United States patients: a retrospective analysis

BMC Pulm Med. 2017 Feb 13;17(1):37. doi: 10.1186/s12890-017-0379-5.


Background: Guidelines suggest observation stays are appropriate for pulmonary embolism (PE) patients at low-risk for early mortality. We sought to assess agreement between United States (US) observation management of PE and claims-based and clinical risk stratification criteria.

Methods: Using US Premier data from 11/2012 to 3/2015, we identified adult observation stay patients with a primary diagnosis of PE, ≥1 PE diagnostic test claim and evidence of PE treatment. The proportion of patients at high-risk was assessed using the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) equation and high-risk characteristics (age > 80 years, heart failure, chronic lung disease, renal or liver disease, high-risk for bleeding, cancer or need for thrombolysis/embolectomy).

Results: We identified 1633 PE patients managed through an observation stay. Despite their observation status, IMPACT classified 46.4% as high-risk for early mortality and 33.3% had ≥1 high-risk characteristic. Co-morbid heart failure, renal or liver disease, high-risk for major bleeding, cancer and hemodynamic instability were low (each <4.5%), but 7.8% were >80 years-of-age and 19.4% had chronic lung disease.

Conclusion: Many PE patients selected for management in observation stay units appeared to have clinical characteristics suggestive of higher-risk for mortality based upon published claims-based and clinical risk stratification criteria.

Keywords: Mortality; Observation stays; Pulmonary embolism; Resource utilization.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Comorbidity
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Observation / methods*
  • Practice Guidelines as Topic
  • Pulmonary Embolism / diagnosis*
  • Pulmonary Embolism / mortality*
  • Retrospective Studies
  • Risk Assessment / methods
  • United States