title: A review on state-of-the-art data regarding safe early discharge following admission for pulmonary embolism: what do we know?
abstract: BACKGROUND
  Although most patients with acute pulmonary embolism (PE) remain hospitalized during initial therapy, some may be suitable for partial or complete outpatient management, which may have a significant impact on healthcare costs.
  
  
  OBJECTIVE
  This article reviews the state-of-the-art data regarding recognition of very-low-risk PE patients who are potentially eligible for outpatient treatment, along with the safety, management, and cost-effectiveness of this strategy. We propose an algorithm based on collected data that may be useful/practical for identifying patients truly eligible for early discharge.
  
  
  METHODS
  Comprehensive review of scientific data collected from the MEDLINE and Cochrane databases. Studies selected based on potential scientific interest. Qualitative information extracted regarding feasibility, safety, and cost-effectiveness of outpatient treatment, postdischarge management, and selection of truly low-risk patients.
  
  
  RESULTS
  Early discharge of low-risk patients seems feasible, safe, and particularly cost-effective. Several risk scores have been developed and/or tested as prediction tools for the recognition of low-risk individuals: the Pulmonary Embolism Severity Index (PESI), simplified PESI, Hestia criteria, Geneva score, the Low-Risk Pulmonary Embolism Decision rule, and the Global Registry of Acute Cardiac Events, among others. PESI is the most well-validated model, offering the safest approach at the current time, especially when combined with additional parameters such as troponin I, N-terminal prohormone of brain natriuretic peptide, and echocardiographic markers of right-ventricular dysfunction.
  
  
  CONCLUSIONS
  Recognition of truly low-risk patients entitled to early hospital discharge and outpatient treatment is possible with current risk-stratification schemes along with selected prognostic parameters, and it may have a colossal impact on healthcare costs.
authors.affiliation: Cardiology Department, Coimbra Hospital and University Centre, Coimbra, Portugal.
authors.forename: Sérgio Nuno Craveiro
authors.initials: SN
authors.lastname: Barra
authors.forename: Luís
authors.initials: L
authors.lastname: Paiva
authors.forename: Rui
authors.initials: R
authors.lastname: Providência
authors.forename: Andreia
authors.initials: A
authors.lastname: Fernandes
authors.forename: António Leitão
authors.initials: AL
authors.lastname: Marques
mesh_terms: D019468:Disease Management; D006801:Humans; D010045:Outpatients; D010343:Patient Admission / Q000639:trends*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011379:Prognosis; D011655:Pulmonary Embolism / Q000628:therapy*; D012042:Registries; D013997:Time Factors