Hospitalizations for High-Risk Pulmonary Embolism

Am J Med. 2021 May;134(5):621-625. doi: 10.1016/j.amjmed.2020.10.029. Epub 2020 Nov 24.


Background: The incidence of pulmonary embolism has been increasing. It has been suggested that this may reflect overdiagnosis due to widespread use of computed tomographic pulmonary angiography. The purpose of the present investigation is to further evaluate whether the increasing incidence of pulmonary embolism represents overdiagnosis.

Methods: This was a retrospective cohort study based on administrative data from the National (Nationwide) Inpatient Sample 1999-2014. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used. The population of the United States according to year was determined from the Centers for Disease Control and Prevention.

Results: The incidence of pulmonary embolism increased from 65/100,000 population in 1999 to 137/100,000 population in 2014 (P < .0001). High-risk pulmonary embolism increased from 2.2/100,000 population to 9.9/100,000 population (P < .0001). The incidence of primary pulmonary embolism increased from 40/100,000 population in 1999 to 73/100,000 population in 2014 (P < .0001). High-risk pulmonary embolism in patients with a primary diagnosis of pulmonary embolism increased from 0.8/100,000 population in 1999 to 2.3/100,000 population in 2014 (P < .0001). Among patients with pulmonary embolism, the incidence of high-risk pulmonary embolism increased from 1999-2014 (P = .0025). In-hospital all-cause mortality in high-risk patients was 102,402 of 195,909 (52.2%).

Conclusions: The incidence of high-risk pulmonary embolism has increased concordantly with the increasing incidence of all pulmonary embolism. Increasing proportions of patients with potentially lethal pulmonary embolism are being diagnosed.

Keywords: CT pulmonary angiography; High-risk; Massive; Pulmonary embolism; Venous thromboembolism.

MeSH terms

  • Aged
  • Female
  • Hospital Mortality
  • Hospitalization / statistics & numerical data
  • Humans
  • Incidence
  • Male
  • Medical Overuse / statistics & numerical data
  • Middle Aged
  • Pulmonary Embolism / diagnosis*
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / epidemiology
  • Pulmonary Embolism / mortality
  • Retrospective Studies
  • Severity of Illness Index
  • United States / epidemiology