title: Factors associated with adverse outcomes in outpatients presenting with pulmonary embolism: the Worcester Venous Thromboembolism Study.
abstract: BACKGROUND
  Data from clinical trials suggest that short-term mortality in outpatients presenting with pulmonary embolism (PE) is low and that outpatient therapy may be appropriate. However, subjects enrolled in these studies may not be representative of patients seen in the community setting.
  
  
  RESULTS
  The medical records of residents from Worcester, Mass, with International Classification of Disease, Ninth Edition, codes consistent with potential venous thromboembolism during 1999, 2001, and 2003 were independently validated and reviewed by trained abstractors. A total of 305 patients presented with PE from the outpatient setting. The rates of recurrent PE, major bleeding, mortality, or occurrence of any 1 of these end points at 90 days were 1.4%, 9.5%, 11.1%, and 20.1%, respectively. Patients with a history of congestive heart failure, recent intensive care unit discharge, cancer, severe infection, systolic blood pressure <100 mm Hg, and male sex were at increased risk for the composite end point.
  
  
  CONCLUSIONS
  In the present population-based study, morbidity and mortality after outpatient PE were much higher than what was observed in clinical studies. Our findings raise questions about broad-based outpatient treatment of PE in the community setting. In our study, comorbid conditions and recent illness were important determinants of adverse outcomes, suggesting that these variables should be carefully considered before embarking on outpatient therapy of PE.
authors.affiliation: Department of Medicine, McMaster University Medical Center, and Thrombosis and Atherosclerosis Research Institute, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. spencerf@ummhc.org
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Spencer
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.forename: George
authors.initials: G
authors.lastname: Reed
authors.forename: Cathy
authors.initials: C
authors.lastname: Emery
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
authors.forename: Luigi
authors.initials: L
authors.lastname: Pacifico
authors.forename: Jeff I
authors.initials: JI
authors.lastname: Weitz
mesh_terms: D000368:Aged; D003153:Community Health Services; D015897:Comorbidity; D003422:Critical Care; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage; D006801:Humans; D007022:Hypotension / Q000453:epidemiology*; D007239:Infections / Q000453:epidemiology*; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D012008:Recurrence; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*