by Dama Ewbank
Greg Fermann, MD, an associate professor in UC’s Department of Emergency Medicine, was recently named the department’s executive vice chairman.
An analysis led by University of Cincinnati (UC) emergency medicine researchers shows that a simplified severity scoring tool for pulmonary embolism could be used in emergency departments to guide treatment decisions and, ultimately, ease the burden placed on emergency departments and hospitals.
The analysis appears in the March 2015 edition of Academic Emergency Medicine, the official journal for the Society for Academic Emergency Medicine.
Pulmonary embolism (PE) is a blockage in one of the arteries leading to the lungs. It is life-threatening and most often caused by a deep vein thrombosis (DVT)—e.g., a blood clot in the leg or pelvis—that travels to the lungs. The Centers for Disease Control and Prevention estimates as many as 900,000 people (1 to 2 per 1,000) could be affected by PE/DVT each year in the United States.
"Patients with symptoms of pulmonary embolism who enter emergency departments in the United States are overwhelmingly admitted to the hospital," says Gregory Fermann, MD, professor and executive vice chairman of UC College of Medicine's Department of Emergency Medicine. "Outside the U.S., patients with pulmonary embolism are much more likely to be treated and released directly from the emergency department."
Fermann and team set out to determine if the widely accepted prognostic tool called the simplified Pulmonary Embolism Severity Index (PESI) could be used to stratify patients according to risk and guide treatment decisions. The simplified PESI score allows risk stratification using physiological criteria.
To do this, the team analyzed results from the international EINSTEIN-PE study, a multi-site, open-label randomized phase III trial comparing treatments for PE. They were able to determine simplified PESI scores for more than 4,800 of the patients enrolled in EINSTEIN-PE.
PESI scores of 0, 1 and ≥2 were given based on specific criteria related to age, health history, pulse, blood pressure and oxygen levels.
With scores in hand, Fermann and team were able to show that patients with PESI scores of 0 or 1 were less likely to experience fatal PE or other adverse outcomes within their first 7, 14, and 30 days post treatment. Patients with PESI scores of ≥2 had more frequent adverse outcomes.
They also showed major bleeding to be lower in the group of EINSTEIN-PE study patients who were given rivaroxaban, noting it was particularly lower in the rivaroxaban patients with simplified PESI scores of 1 or ≥2. Rivaroxaban (marketed under the brand name Xarelto) is an oral anti-coagulant (blood-thinning) medication developed together by Janssen and Bayer HealthCare.
"The results of this analysis provide further support that risk stratification of PE patients may allow a cohort of low-risk patients to be treated in a clinical decision unit or by a closely monitored outpatient strategy, rather than an inpatient setting," says Fermann. "But while physiological criteria such as the PESI score are important, the decision to admit or discharge a patient is also based on sociobehavioral factors, like the patient's ability to go to a primary care provider or to get their medicine."
Explore further: First recommendations on all new oral anticoagulants in pulmonary embolism published
Medical Xpress on facebook
Related Stories
First recommendations on all new oral anticoagulants in pulmonary embolism published
The first recommendations on the use of all new oral anticoagulants in pulmonary embolism are published today in new ESC Guidelines. The guidelines are launched at ESC Congress by Professor Stavros V. Konstantinides (Germany/Greece) ...
Risk of pulmonary embolism greatest during first week following total joint replacement
The elevated risk of pulmonary embolism (PE) – a blood clot that travels from the leg to the lungs – following total joint replacement (TJR) surgery has been well established, yet little is known about the natural ...
Analysis finds mixed results for use of thrombolytic therapy for blood clot in lungs
In an analysis that included data from 16 trials performed over the last 45 years, among patients with pulmonary embolism, receipt of therapy to dissolve the blood clot (thrombolysis) was associated with lower rates of death, ...
Outpatient treatment proves safe, effective for low-risk patients with pulmonary embolism
Outpatient care for certain low-risk patients with pulmonary embolism (PE) can be safely and effectively used in place of inpatient care, according to a randomized, multi-center study in 19 emergency departments. The findings, ...
Hospitalizations for pulmonary embolism vary by season
(HealthDay)—Hospitalizations for pulmonary embolism (PE) are higher in the winter and lower in the summer, according to a study published online Oct. 31 in the Journal of Thrombosis and Homeostasis.
Recommended for you
The connection between listeriosis and produce
In the United States and other industrialized nations, consumption of fresh fruits and vegetables is considered a key component of a healthy diet.
Why gastrointestinal disorders afflict women more often
Women are more likely to have irritable bowel syndrome and other gastrointestinal (GI) disorders than men are. Although this could be because men and women handle the condition differently— "toughing it out" versus getting ...
Study reveals new information on climate drivers of Dengue fever
Researchers at Upstate Medical University, in collaboration with a team of international investigators studying dengue fever, have discovered new information on climate drivers of the disease and social risk factors that ...
Synthetic pot linked to kidney injury
(HealthDay)—New research suggests that synthetic marijuana, also known as K2 or Spice, might harm the kidneys.
Scientists link unexplained childhood paralysis to enterovirus D68
A research team led by UC San Francisco scientists has found the genetic signature of enterovirus D68 (EV-D68) in half of California and Colorado children diagnosed with acute flaccid myelitis - sudden, unexplained ...
Amid bird flu outbreak, turkey farmers increase security
Poultry producers in the nation's top turkey state are taking extra steps to protect their flocks after a devastating strain of bird flu was confirmed at two Minnesota farms in as many days last week, a disease that had already ...
User comments
Please sign in to add a comment. Registration is free, and takes less than a minute. Read more
Click here to reset your password.
Sign in to get notified via email when new comments are made.
by Dama Ewbank
Greg Fermann, MD, an associate professor in UC’s Department of Emergency Medicine, was recently named the department’s executive vice chairman.
An analysis led by University of Cincinnati (UC) emergency medicine researchers shows that a simplified severity scoring tool for pulmonary embolism could be used in emergency departments to guide treatment decisions and, ultimately, ease the burden placed on emergency departments and hospitals.
The analysis appears in the March 2015 edition of Academic Emergency Medicine, the official journal for the Society for Academic Emergency Medicine.
Pulmonary embolism (PE) is a blockage in one of the arteries leading to the lungs. It is life-threatening and most often caused by a deep vein thrombosis (DVT)—e.g., a blood clot in the leg or pelvis—that travels to the lungs. The Centers for Disease Control and Prevention estimates as many as 900,000 people (1 to 2 per 1,000) could be affected by PE/DVT each year in the United States.
"Patients with symptoms of pulmonary embolism who enter emergency departments in the United States are overwhelmingly admitted to the hospital," says Gregory Fermann, MD, professor and executive vice chairman of UC College of Medicine's Department of Emergency Medicine. "Outside the U.S., patients with pulmonary embolism are much more likely to be treated and released directly from the emergency department."
Fermann and team set out to determine if the widely accepted prognostic tool called the simplified Pulmonary Embolism Severity Index (PESI) could be used to stratify patients according to risk and guide treatment decisions. The simplified PESI score allows risk stratification using physiological criteria.
To do this, the team analyzed results from the international EINSTEIN-PE study, a multi-site, open-label randomized phase III trial comparing treatments for PE. They were able to determine simplified PESI scores for more than 4,800 of the patients enrolled in EINSTEIN-PE.
PESI scores of 0, 1 and ≥2 were given based on specific criteria related to age, health history, pulse, blood pressure and oxygen levels.
With scores in hand, Fermann and team were able to show that patients with PESI scores of 0 or 1 were less likely to experience fatal PE or other adverse outcomes within their first 7, 14, and 30 days post treatment. Patients with PESI scores of ≥2 had more frequent adverse outcomes.
They also showed major bleeding to be lower in the group of EINSTEIN-PE study patients who were given rivaroxaban, noting it was particularly lower in the rivaroxaban patients with simplified PESI scores of 1 or ≥2. Rivaroxaban (marketed under the brand name Xarelto) is an oral anti-coagulant (blood-thinning) medication developed together by Janssen and Bayer HealthCare.
"The results of this analysis provide further support that risk stratification of PE patients may allow a cohort of low-risk patients to be treated in a clinical decision unit or by a closely monitored outpatient strategy, rather than an inpatient setting," says Fermann. "But while physiological criteria such as the PESI score are important, the decision to admit or discharge a patient is also based on sociobehavioral factors, like the patient's ability to go to a primary care provider or to get their medicine."
Explore further: First recommendations on all new oral anticoagulants in pulmonary embolism published
Medical Xpress on facebook
Related Stories
First recommendations on all new oral anticoagulants in pulmonary embolism published
The first recommendations on the use of all new oral anticoagulants in pulmonary embolism are published today in new ESC Guidelines. The guidelines are launched at ESC Congress by Professor Stavros V. Konstantinides (Germany/Greece) ...
Risk of pulmonary embolism greatest during first week following total joint replacement
The elevated risk of pulmonary embolism (PE) – a blood clot that travels from the leg to the lungs – following total joint replacement (TJR) surgery has been well established, yet little is known about the natural ...
Analysis finds mixed results for use of thrombolytic therapy for blood clot in lungs
In an analysis that included data from 16 trials performed over the last 45 years, among patients with pulmonary embolism, receipt of therapy to dissolve the blood clot (thrombolysis) was associated with lower rates of death, ...
Outpatient treatment proves safe, effective for low-risk patients with pulmonary embolism
Outpatient care for certain low-risk patients with pulmonary embolism (PE) can be safely and effectively used in place of inpatient care, according to a randomized, multi-center study in 19 emergency departments. The findings, ...
Hospitalizations for pulmonary embolism vary by season
(HealthDay)—Hospitalizations for pulmonary embolism (PE) are higher in the winter and lower in the summer, according to a study published online Oct. 31 in the Journal of Thrombosis and Homeostasis.
Recommended for you
The connection between listeriosis and produce
In the United States and other industrialized nations, consumption of fresh fruits and vegetables is considered a key component of a healthy diet.
Why gastrointestinal disorders afflict women more often
Women are more likely to have irritable bowel syndrome and other gastrointestinal (GI) disorders than men are. Although this could be because men and women handle the condition differently— "toughing it out" versus getting ...
Study reveals new information on climate drivers of Dengue fever
Researchers at Upstate Medical University, in collaboration with a team of international investigators studying dengue fever, have discovered new information on climate drivers of the disease and social risk factors that ...
Synthetic pot linked to kidney injury
(HealthDay)—New research suggests that synthetic marijuana, also known as K2 or Spice, might harm the kidneys.
Scientists link unexplained childhood paralysis to enterovirus D68
A research team led by UC San Francisco scientists has found the genetic signature of enterovirus D68 (EV-D68) in half of California and Colorado children diagnosed with acute flaccid myelitis - sudden, unexplained ...
Amid bird flu outbreak, turkey farmers increase security
Poultry producers in the nation's top turkey state are taking extra steps to protect their flocks after a devastating strain of bird flu was confirmed at two Minnesota farms in as many days last week, a disease that had already ...
User comments
Please sign in to add a comment. Registration is free, and takes less than a minute. Read more
Click here
to reset your password.
Sign in to get notified via email when new comments are made.
0 comments:
Post a Comment