Abstract Number: PB2483
Meeting: ISTH 2020 Congress
Background: Pulmonary Embolism Severity Index (PESI) is an extensively validated prognostic score on the risk of adverse events after acute pulmonary embolism (PE). However, impact analyses on management strategies, patient outcomes and health care costs are lacking
Aims: To assess whether the adoption of PESI helps physicians to correctly identify PE patients at low-risk of adverse events and to safely provide early discharge thus reducing the length of hospital stay (LOS) in internal medicine units
Methods: Multicenter randomized controlled trial, enrolling consecutive adult outpatients diagnosed with acute PE. Within 48 hours from diagnosis, treating physicians were centrally randomized, for every patient, to formally calculate PESI and reporting it in the clinical record form or to routine practice. Randomization was stratified by the intended treatment choice. The primary outcome was LOS.To find a statistically significant difference in the mean LOS of the two groups, 220 patients for each group were needed. ClinicalTrials.gov identifier NCT03002467.
Results: The study was prematurely interrupted due to slow recruitment rate. A total of 125 patients were enrolled at six internal medicine units, from 2016 to 2019. The mean age was 75.6 years (standard deviation, SD, 12.8). Treating physicians were randomized to the use of PESI for 61 patients or to perform routine practice for 64 patients. Overall, the mean PESI score was high (116.3, SD 47.5) and was similar between the two groups (115.5 and 117.1, respectively). The mean LOS was 10.1 days (SD 8.1) and was similar between the two groups (10 days, SD 8.7 and 10.3 days, SD 7.6, respectively).
Conclusions: The use of PESI in patients admitted to internal medicine divisions did not impact on the duration of hospital stay.
To cite this abstract in AMA style:Donadini MP, Mumoli N, Fenu P, Pomero F, Re R, Palmiero G, Spadafora L, Mazzi V, Grittini A, Aujesky D, Dentali F, Ageno W, Squizzato A. Impact Analysis of Prognostic Stratification for Pulmonary Embolism (iAPP): A Randomized Controlled Trial [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/impact-analysis-of-prognostic-stratification-for-pulmonary-embolism-iapp-a-randomized-controlled-trial/. Accessed January 23, 2022.
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