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Multicenter Study
. 2024 Jan:233:181-188.
doi: 10.1016/j.thromres.2023.12.003. Epub 2023 Dec 13.

Discharge from the emergency department and outpatient clinic in cancer patients with acute symptomatic and incidental pulmonary embolism: A multicenter retrospective cohort study

N A M Guman  1 , F H J Kaptein  2 , S B Lohle  3 , A T A Mairuhu  4 , F A Klok  2 , M V Huisman  2 , P W Kamphuisen  5 , N van Es  3
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Free article
Multicenter Study

Discharge from the emergency department and outpatient clinic in cancer patients with acute symptomatic and incidental pulmonary embolism: A multicenter retrospective cohort study

N A M Guman et al. Thromb Res. 2024 Jan.
Free article

Abstract

Background: It is unclear how often cancer patients with acute pulmonary embolism (PE) are discharged from the emergency department (ED) or outpatient clinic and whether direct discharge is safe. We assessed treatment setting and early safety outcomes in cancer patients with acute symptomatic and incidental PE.

Methods: Cancer patients diagnosed with PE at the ED or outpatient clinic between August 2017 and May 2021 were included in Four Cities VTE Cancer, a Dutch multicenter retrospective cohort study. The main outcome was direct discharge versus hospitalization. Safety outcomes were cumulative 14-day mortality and PE-related readmission incidences.

Results: We included 602 patients (median age 71 years; 49.5 % female) of whom 285 (47.3 %) were discharged directly and 317 (52.7 %) were hospitalized. The cumulative 14-day mortality incidence was 0.7 % (95 % CI, 0.1-2.4 %) in patients discharged directly and 9.0 % (95 % CI, 6.2-12.5 %) in those hospitalized. The cumulative 14-day PE-related readmission incidence was 1.8 % (95 % CI, 0.7-3.9 %) and 1.4 % (95 % CI, 0.5-3.3 %) in directly discharged and hospitalized patients, respectively. Of the 220 patients with incidental PE, 180 (81.8 %) were discharged directly compared to 105 of 382 (27.5 %) patients with symptomatic PE (P < 0.001). Mortality and readmission incidences in symptomatic and incidental PE were consistent with the main analysis.

Conclusions: About 28 % and 82 % of cancer patients with symptomatic or incidental PE, respectively, were discharged directly, with low 14-day mortality and PE-related readmission incidences. These data underline the need for PE risk stratification in oncological populations and suggest that clinicians successfully identify a proportion of patients in whom direct discharge is safe.

Keywords: Hospitalization; Neoplasms; Patient discharge; Pulmonary embolism; Risk assessment.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: N.A.M. Guman, F.H.J. Kaptein, A.T.A. Mairuhu, and S. Lohle have no conflicts of interest to declare. F.A. Klok has received research support from Bayer, Bristol-Myers Squibb, Boehringer-Ingelheim, MSD, VarmX, Daiichi-Sankyo, Actelion, The Netherlands Organisation for Health Research and Development, The Dutch Thrombosis Association, The Dutch Heart Foundation and the Horizon Europe Program, all unrelated to this work and paid to his institution. M.V. Huisman has received research grants from Dutch Healthcare Fund, Dutch Heart Foundation, Bayer Health Care, Pfizer, BMS, Boehringer-Ingelheim, Leo Pharma. P.W. Kamphuisen has received research grants from Daiichi Sankyo and Roche Diagnostics and the Tergooi academy, all transferred to his institute. N. van Es reports advisory board honoraria from Daiichi-Sankyo, Bayer, and LEO Pharma, which were transferred to his institute.

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