Admission Patterns and Clinical Outcomes in a Regional Cohort of Low-Intermediate Risk Pulmonary Embolism Patients

Files

Authors

• Larissa Dean, Michigan State University College of Human Medicine Medical Student
• Justin Romero, Michigan State University College of Human Medicine Medical Student
• John Oostema, Corewell Health West
• Joshua Reynolds, Corewell Health West

Description

In the absence of hypotension or hypoxia, pulmonary embolism (PE) often follows a benign course. Risk tools such as the simplified pulmonary embolism severity index (sPESI) support outpatient management of stable cases; however, current guidelines recommend hospitalization for any evidence of right ventricular (RV) strain-whether by CT or elevated troponin (hs-cTnT)-regardless of sPESI. We aimed to quantify admission rates and the risk of clinical deterioration or therapy escalation among low-intermediate risk patients per ESC guidelines.

We conducted a retrospective cohort study of patients with newly diagnosed PE across eight rural and urban EDs in 2025, excluding cases with hypotension (SBP < 100 mmHg) or new hypoxia (SpO₂ < 90%). Clinical, laboratory, and imaging data were abstracted for seven days following the index ED visit. RV strain was defined as CT RV:LV ratio ≥0.9 or hs-cTnT >14 ng/dL. The primary outcome was a composite of clinical deterioration, death, or mechanical thrombectomy within 72 hours.

Of 250 stable PE cases, 148 (59%) were low-intermediate risk. Among these, 107 (72%) were hospitalized and 41 (28%) discharged. The primary outcome occurred in 22 (15%) cases-all initially admitted. Most admitted cases were sPESI+ (74%) and accounted for 91% of adverse events. Among 38 sPESI- patients, two adverse events occurred, both in those with elevated troponins; none occurred in patients with CT evidence of RV strain. ED clinicians discharged 18 (47%) sPESI- cases despite the presence of either RV strain or troponin elevation and 23 (21%) sPESI+ cases. A single discharged case (sPESI-) was admitted within 72 hours for analgesia.

In a regional sample of low-intermediate risk PE, ED clinicians safely discharged nearly one-third of patients despite guideline recommendations for hospitalization. Nearly all adverse outcomes occurred among sPESI+ cases regardless of CT or biomarker evidence of RV strain. These data suggest call into question the value of surrogate estimates for RV strain as an adjunct to sPESI and clinical judgment.

Publication Date

5-8-2026

Disciplines

Emergency Medicine

Recommended Citation

Dean L, Romero J, Oostema J, Reynolds J. Admission patterns and clinical outcomes in a regional cohort of low-intermediate risk pulmonary embolism patients. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2139