Detalle Publicación

Randomised controlled trial of a prognostic assessment and management pathway to reduce the length of hospital stay in normotensive patients with acute pulmonary embolism

Autores: Jiménez, D. (Autor de correspondencia); Rodríguez, C.; León, F.; Jara-Palomares, L.; López-Reyes, R.; Ruiz Artacho, Pedro Celso; Elías, T.; Otero, R.; García-Ortega, A.; Rivas-Guerrero, A.; Abelaira, J.; Jiménez, S.; Muriel, A.; Morillo, R.; Barrios, D.; Le Mao, R.; Yusen, R. D.; Bikdeli, B.; Monreal, M.; Lobo, J. L.
Título de la revista: EUROPEAN RESPIRATORY JOURNAL
ISSN: 0903-1936
Volumen: 59
Número: 2
Páginas: 2100412
Fecha de publicación: 2022
Resumen:
Background The length of hospital stay (LOS) for acute pulmonary embolism (PE) varies considerably. Whether the upfront use of a PE prognostic assessment and management pathway is effective in reducing the LOS remains unknown. Methods We conducted a randomised controlled trial of adults hospitalised for acute PE: patients were assigned either to a prognostic assessment and management pathway involving risk stratification followed by predefined criteria for mobilisation and discharge (intervention group) or to usual care (control group). The primary end-point was LOS. The secondary end-points were the cost of prognostic tests and of hospitalisation, and 30-day clinical outcomes. Results Of 500 patients who underwent randomisation, 498 were included in the modified intention-to-treat analysis. The median LOS was 4.0 days (interquartile range (IQR) 3.7-4.2 days) in the intervention group and 6.1 days (IQR 5.7-6.5 days) in the control group (p<0.001). The mean total cost of prognostic tests was EUR 174.76 in the intervention group, compared with EUR 233.12 in the control group (mean difference EUR -58.37, 95% CI EUR -84.34 to -32.40). The mean total hospitalisation cost per patient was EUR 2085.66 in the intervention group, compared with EUR 3232.97 in the control group (mean difference EUR -1147.31, 95% CI EUR -1414.97 to -879.65). No significant differences were observed in 30-day readmission (4.0% versus 4.8%), all-cause mortality (2.4% versus 2.0%) or PE-related mortality (0.8% versus 1.2%) rates. Conclusions The use of a prognostic assessment and management pathway was effective in reducing the LOS for acute PE.
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