title: Observation management of pulmonary embolism and agreement with claims-based and clinical risk stratification criteria in United States patients: a retrospective analysis.
abstract: BACKGROUND
  Guidelines suggest observation stays are appropriate for pulmonary embolism (PE) patients at low-risk for early mortality. We sought to assess agreement between United States (US) observation management of PE and claims-based and clinical risk stratification criteria.
  
  
  METHODS
  Using US Premier data from 11/2012 to 3/2015, we identified adult observation stay patients with a primary diagnosis of PE, ≥1 PE diagnostic test claim and evidence of PE treatment. The proportion of patients at high-risk was assessed using the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) equation and high-risk characteristics (age > 80 years, heart failure, chronic lung disease, renal or liver disease, high-risk for bleeding, cancer or need for thrombolysis/embolectomy).
  
  
  RESULTS
  We identified 1633 PE patients managed through an observation stay. Despite their observation status, IMPACT classified 46.4% as high-risk for early mortality and 33.3% had ≥1 high-risk characteristic. Co-morbid heart failure, renal or liver disease, high-risk for major bleeding, cancer and hemodynamic instability were low (each <4.5%), but 7.8% were >80 years-of-age and 19.4% had chronic lung disease.
  
  
  CONCLUSIONS
  Many PE patients selected for management in observation stay units appeared to have clinical characteristics suggestive of higher-risk for mortality based upon published claims-based and clinical risk stratification criteria.
authors.affiliation: University of Connecticut School of Pharmacy, 69 North Eagleville Road, Unit 3092, Storrs, CT, 06269, USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Nguyen
authors.affiliation: University of Connecticut School of Pharmacy, 69 North Eagleville Road, Unit 3092, Storrs, CT, 06269, USA. craig.coleman@hhchealth.org.
authors.forename: Craig I
authors.initials: CI
authors.lastname: Coleman
authors.affiliation: Department of Emergency Medicine, Baylor College of Medicine, 1504 Taub Loop, Houston, TX, USA.
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, 501 Smyth Road, Box 206, Ottawa, ON, Canada.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Wells
authors.affiliation: University of Connecticut School of Pharmacy, 69 North Eagleville Road, Unit 3092, Storrs, CT, 06269, USA.
authors.forename: Erin R
authors.initials: ER
authors.lastname: Weeda
authors.affiliation: Janssen Scientific Affairs, LLC, 1000 Route 202, Raritan, NJ, USA.
authors.forename: Veronica
authors.initials: V
authors.lastname: Ashton
authors.affiliation: Janssen Scientific Affairs, LLC, 1000 Route 202, Raritan, NJ, USA.
authors.forename: Concetta
authors.initials: C
authors.lastname: Crivera
authors.affiliation: Janssen Scientific Affairs, LLC, 1000 Route 202, Raritan, NJ, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Wildgoose
authors.affiliation: Janssen Scientific Affairs, LLC, 1000 Route 202, Raritan, NJ, USA.
authors.forename: Jeff R
authors.initials: JR
authors.lastname: Schein
authors.affiliation: New England Health Analytics, LLC, Granby, CT, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Bunz
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Fermann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation / Q000379:methods*; D017410:Practice Guidelines as Topic; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D014481:United States
keywords: Mortality; Observation stays; Pulmonary embolism; Resource utilization