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Outpatient treatment of pulmonary embolism
  1. Kerstin Hogg, Clinical Research Fellow,
  2. Debbie Dawson, Clinical Research Nurse
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones:man.ac.uk

    Abstract

    A short cut review was carried out to establish whether outpatient treatment of patients with pulmonary embolus is a safe strategy. Sixty six papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

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    Report by Kerstin Hogg,Clinical Research FellowChecked by Debbie Dawson, Clinical Research Nurse

    Clinical scenario

    A 40 year old woman presents to the emergency department with pleuritic chest pain. She comments that she has had “cramp” in her left leg since discharge from the surgical ward after hysterectomy. Her ventilation-perfusion scan shows a high probability of pulmonary embolism. You have scored her as a high clinical probability of PE and therefore diagnose pulmonary embolic disease. She is comfortable, has normal oxygen saturations and is keen to return home to her family. You wonder whether treating her as a outpatient would be a safe option.

    Three part question

    Is it [safe] to treat a patient with [pulmonary embolic disease] as an [outpatient]?

    Search strategy

    Medline 1966–04/03 using the OVID interface. [(pulmonary embol$.mp OR exp Pulmonary Embolism OR PE.mp OR exp Thromboembolism OR pulmonary infarct$.mp) AND (treatment.mp OR exp Therapeutics OR LMWH.mp OR exp Heparin, Low-Molecular-Weight OR low molecular weight.mp OR exp Anticoagulants) AND (outpatient.mp OR exp Outpatients OR clinic.mp OR exp Outpatient clinics, hospital)] LIMIT to human AND English.

    Search outcome

    Altogether 282 papers were found, of which three were relevant (table 10).

    Table 10

    Comment(s)

    There are no large studies validating this approach to the treatment of pulmonary embolism.

    CLINICAL BOTTOM LINE

    It may be safe to treat a low risk group of patients with pulmonary embolic disease at home.

    Report by Kerstin Hogg,Clinical Research FellowChecked by Debbie Dawson, Clinical Research Nurse

    References

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