Outcomes of patients with acute pulmonary embolism managed in-house vs those transferred between hospitals: a retrospective observational study

IF 3.4 3区 医学 Q2 HEMATOLOGY
Priyanka Sridhar , Hong Yu Wang , Agostina Velo , Destiny Nguyen , Avinash Singh , Abdul Rehman , Jason Filopei , Madeline Ehrlich , Robert Lookstein , David J. Steiger
{"title":"Outcomes of patients with acute pulmonary embolism managed in-house vs those transferred between hospitals: a retrospective observational study","authors":"Priyanka Sridhar ,&nbsp;Hong Yu Wang ,&nbsp;Agostina Velo ,&nbsp;Destiny Nguyen ,&nbsp;Avinash Singh ,&nbsp;Abdul Rehman ,&nbsp;Jason Filopei ,&nbsp;Madeline Ehrlich ,&nbsp;Robert Lookstein ,&nbsp;David J. Steiger","doi":"10.1016/j.rpth.2024.102606","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Interhospital transfer (IHT) for acute pulmonary embolism (PE) is increasingly performed to improve access to advanced reperfusion therapies. It is unclear if outcomes of patients undergoing IHT are comparable with those of patients presenting in-house to hospitals with PE Response Team (PERT) capabilities.</div></div><div><h3>Objectives</h3><div>To determine whether outcomes of patients with acute PE undergoing IHT differ from those of patients presenting in-house.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 386 patients with acute PE who were treated by PERT at 1 of 3 urban teaching hospitals in the Mount Sinai Health System in New York City from January 2021 to October 2023. Propensity score–weighted analysis was performed to compare the outcomes of patients managed in-house with those of patients undergoing IHT.</div></div><div><h3>Results</h3><div>Two hundred eighty-four patients presented in-house, while 102 were transferred from other hospitals. Median PE Severity Index score was 84, and 3 (0.8%), 80 (20.7%), 237 (61.4%), and 66 (17.1%) had low-risk, intermediate low–risk, intermediate high–risk, and high-risk PE. Odds of receiving systemic thrombolysis (odds ratio [OR], 1.06; <em>P</em> = .06) or advanced therapies (OR, 0.95; <em>P</em> = .003) were not significantly different between the 2 groups. Rates of 30-day mortality, major bleeding, and readmission were 6.9%, 2.9%, and 9.8% for the IHT group and 10.6%, 2.1%, and 13% for the in-house group, respectively. IHT patients had lower odds of 30-day mortality (OR, 0.88; <em>P</em> = .003) and higher odds of major bleeding (OR, 1.03; <em>P</em> = .04).</div></div><div><h3>Conclusion</h3><div>PERT-guided IHT for patients with acute PE was associated with reduced mortality but increased risk of bleeding compared with patients managed in-house at hospitals with PERT capabilities.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"8 8","pages":"Article 102606"},"PeriodicalIF":3.4000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Research and Practice in Thrombosis and Haemostasis","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2475037924003017","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEMATOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background

Interhospital transfer (IHT) for acute pulmonary embolism (PE) is increasingly performed to improve access to advanced reperfusion therapies. It is unclear if outcomes of patients undergoing IHT are comparable with those of patients presenting in-house to hospitals with PE Response Team (PERT) capabilities.

Objectives

To determine whether outcomes of patients with acute PE undergoing IHT differ from those of patients presenting in-house.

Methods

We retrospectively reviewed 386 patients with acute PE who were treated by PERT at 1 of 3 urban teaching hospitals in the Mount Sinai Health System in New York City from January 2021 to October 2023. Propensity score–weighted analysis was performed to compare the outcomes of patients managed in-house with those of patients undergoing IHT.

Results

Two hundred eighty-four patients presented in-house, while 102 were transferred from other hospitals. Median PE Severity Index score was 84, and 3 (0.8%), 80 (20.7%), 237 (61.4%), and 66 (17.1%) had low-risk, intermediate low–risk, intermediate high–risk, and high-risk PE. Odds of receiving systemic thrombolysis (odds ratio [OR], 1.06; P = .06) or advanced therapies (OR, 0.95; P = .003) were not significantly different between the 2 groups. Rates of 30-day mortality, major bleeding, and readmission were 6.9%, 2.9%, and 9.8% for the IHT group and 10.6%, 2.1%, and 13% for the in-house group, respectively. IHT patients had lower odds of 30-day mortality (OR, 0.88; P = .003) and higher odds of major bleeding (OR, 1.03; P = .04).

Conclusion

PERT-guided IHT for patients with acute PE was associated with reduced mortality but increased risk of bleeding compared with patients managed in-house at hospitals with PERT capabilities.

Abstract Image

急性肺栓塞住院治疗患者与转院患者的预后:一项回顾性观察性研究
背景:急性肺栓塞(PE)的医院间转移(IHT)越来越多地用于改善高级再灌注治疗的可及性。目前尚不清楚接受IHT的患者的结果是否与那些在具有PE反应小组(PERT)能力的医院内部就诊的患者的结果相当。目的确定急性肺心病患者接受IHT治疗的结果是否与住院患者不同。方法回顾性分析了2021年1月至2023年10月在纽约市西奈山卫生系统3所城市教学医院中的1所接受PERT治疗的386例急性PE患者。采用倾向评分加权分析比较内部管理的患者和接受IHT治疗的患者的结果。结果本院住院284例,外院转诊102例。PE严重性指数中位数为84,低危、中危、中危和高危PE分别为3(0.8%)、80(20.7%)、237(61.4%)和66(17.1%)。接受全身溶栓治疗的几率(优势比[OR], 1.06;P = .06)或先进疗法(or, 0.95;P = 0.003),两组间差异无统计学意义。IHT组30天死亡率、大出血和再入院率分别为6.9%、2.9%和9.8%,住院组为10.6%、2.1%和13%。IHT患者30天死亡率较低(OR, 0.88;P = 0.003),大出血的几率更高(OR, 1.03;P = .04)。结论与有PERT能力的医院内部管理的患者相比,PERT引导下的急性PE患者的IHT与死亡率降低相关,但出血风险增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
5.60
自引率
13.00%
发文量
212
审稿时长
7 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信