Clinical studyUse of pulse oximetry to predict in-hospital complications in normotensive patients with pulmonary embolism☆
Section snippets
Derivation study
Data were collected prospectively in two phases: a derivation and validation phase. The derivation phase was conducted in emergency departments at seven urban teaching hospitals in the United States. This study was reviewed and approved by the Institutional Review Board for research on human subjects at all institutions. Patients were enrolled in the study when a board-certified emergency department physician ordered a pulmonary vascular imaging study (either a contrast-enhanced computerized
Derivation phase
The derivation set consisted of a sample of 1195 emergency department patients evaluated for pulmonary embolism, of whom 212 (18%) were diagnosed with pulmonary embolism (Table 1). We excluded 5 patients with pulmonary embolism (fibrinolytic agent given in the emergency department [n = 1], no treatment given [n = 3], vasopressor treatment for hypotension after enrollment but before diagnosis [n = 1]). Of the remaining 207 patients, 21 (10%) died during the subsequent 30 days, at a median of
Discussion
Among 303 normotensive patients with pulmonary embolism treated initially with heparin anticoagulation, we observed an in-hospital mortality rate of 10%, which agrees with previous results in similar patients (4, 5, 17). In our study, 4% of nonhypotensive patients with pulmonary embolism died within 24 hours of diagnosis. None of these patients had malignancy or advanced cardiopulmonary disease. These data suggest the value of an accurate method to recognize patients at risk of short-term
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This study was supported by the Emergency Medicine Foundation, Irving, Texas.