Outpatient investigation of pulmonary embolism
Date First Published:
March 19, 2003
Last Updated:
July 1, 2003
Report by:
Kerstin Hogg, Clinical Research Fellow (Manchester Royal Infirmary)
Search checked by:
Debbie Dawson, Manchester Royal Infirmary
Three-Part Question:
In a [patient with suspected pulmonary embolism] is [outpatient investigation] [safe]?
Clinical Scenario:
A 38 year old man presents to the emergency department with left posterior pleuritic chest pain. He had a DVT 8 years ago and his D-dimer levels are elevated. He is haemodynamically stable with normal oxygen saturations, ECG and chest Xray. You would like to rule out a pulmonary embolism, but it is 8pm. You wonder whether it would be safe to discharge the patient home overnight before his VQ scan tomorrow.
Search Strategy:
Medline 1966-04/03 using the OVID interface.
Search Details:
[(pulmonary embol$.mp OR exp Pulmonary Embolism OR PE.mp OR exp Thromboembolism OR pulmonary infarct$.mp) AND (diagnosis.mp OR exp Diagnosis) AND (outpatient.mp OR exp Outpatients OR clinic.mp OR exp Outpatent clinics, hospital)] LIMIT to human AND English.
Outcome:
198 papers were found, one of which looked at outpatient investigation of patients with suspected PE.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Dalteparin in emergency patients to prevent admission prior to investigation for venous thromboembolism. Bauld DL, Kovacs MJ. 1999, Canada | 128 emergency department patients – 50 with suspected PE, the rest suspected DVT All given one dose of dateparin and discharged overnight prior to investigations |
Prospective cohort | Adverse events | 6% had bruising at injection site<br><br>No other adverse events relating to outpatient investigation | Small study numbers |
Author Commentary:
This is the only published study looking at outpatient investigation of PE and is small. Further research is needed.
Bottom Line:
It may be safe to investigate selected patients with suspected pulmonary embolus at home.
References:
- Bauld DL, Kovacs MJ.. Dalteparin in emergency patients to prevent admission prior to investigation for venous thromboembolism.