RT Journal Article
SR Electronic
T1 Factors associated with clinical deterioration shortly after PE
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 835
OP 842
DO 10.1136/thoraxjnl-2013-204762
VO 69
IS 9
A1 Kabrhel, Christopher
A1 Okechukwu, Ikenna
A1 Hariharan, Praveen
A1 Takayesu, James Kimo
A1 MacMahon, Peter
A1 Haddad, Faris
A1 Chang, Yuchiao
YR 2014
UL http://thorax.bmj.com/content/69/9/835.abstract
AB Background Several factors have been associated with mortality in the months after PE. Factors associated with short-term clinical deterioration or need for hospital-based intervention are less well known. Methods We prospectively enrolled consecutive emergency department patients with PE and recorded clinical, biomarker and radiographic data. We assessed hospitalised patients daily to identify clinical deterioration or need for hospital-based intervention for 5 days after PE. We captured postdischarge events via 5-day and 30-day interviews. We used univariate and multivariable models to assess associations with clinical deterioration, severe clinical deterioration and 30-day all-cause mortality. We also assessed the test characteristics of three published clinical decision rules. Results We enrolled 298 patients with PE: mean age 59 (SD±17) years; 152 (51%) male and 268 (90%) white race. 101 (34%) patients clinically deteriorated or required a hospital-based intervention within 5 days, and 197 (66%) did not. 27 (9%) patients suffered severe clinical deterioration and 12 died within 30 days. Factors independently associated with clinical deterioration were hypotension (p=0.001), hypoxia (p<0.001), coronary disease (p=0.004), residual deep vein thrombosis (p=0.006) and right heart strain on echocardiogram (p<0.001). In contrast, factors associated with 30-day all-cause mortality were active malignancy (p<0.001) and congestive heart failure (p=0.009). The sensitivity of clinical decision rules was moderate (39–80%) for 5-day clinical deterioration but higher (67–100%) for 30-day mortality. Conclusions Most patients do not clinically deteriorate after PE diagnosis. Several factors are associated with short-term clinical deterioration, but these factors differ from those associated with 30-day mortality.