Predictors of Stable Pulmonary Embolus

Outpatient management of pulmonary embolus (PE) is gaining attention (NEJM JW Emerg Med Nov 30 2012). But which patients are safe for discharge? Investigators performed a secondary analysis of data from an Italian registry of PE cases to determine whether the combination of troponin testing and echocardiography could predict in-hospital death or clinical deterioration.

Of 1515 hemodynamically stable patients in the registry, 869 had troponin measurement and echocardiography results. Of note, the authors did not define “hemodynamically stable” or the criteria for testing.

Death or clinical deterioration occurred in 8.8% of patients with right ventricular dysfunction and troponin elevation, in 4.7% with one of these characteristics, and in 0.5%…