From the Guidelines
The scoring tool for determining outpatient versus inpatient admission for a patient with pulmonary embolism (PE) is the Pulmonary Embolism Severity Index (PESI) or its simplified version (sPESI), as well as the Hestia criteria.
Scoring Tools
- PESI: original form with a score < 85 or the simplified form with a score of 0, can help to identify low-risk patients who are suitable for treatment at home 1.
- sPESI: a score of 0 indicates low risk and suitability for outpatient management 1.
- Hestia criteria: also used to identify patients suitable for outpatient management of PE 1.
Clinical Decision Making
These clinical decision rules are aids to decision-making and do not require patients to have a predefined score to be considered for treatment at home 1. The presence of right ventricular dysfunction or increased cardiac biomarker levels should discourage treatment out of the hospital 1.
Guidance
The Chest guideline recommends outpatient treatment over hospitalization for patients with low-risk PE, provided access to medications, ability to access outpatient care, and home circumstances are adequate (strong recommendation, low-certainty evidence) 1.
From the Research
Scoring Tools for Outpatient vs Inpatient Admission
The decision to admit a patient with pulmonary embolism (PE) as an inpatient or outpatient can be guided by several scoring tools, including:
- The Pulmonary Embolism Severity Index (PESI) 2, 3
- The HESTIA score 2, 4, 5, 6
- The simplified PESI 3
- The Geneva score 3
- The Low-Risk Pulmonary Embolism Decision rule 3
- The Global Registry of Acute Cardiac Events 3
Key Features of Scoring Tools
These scoring tools assess various factors, such as:
- Clinical parameters (e.g., blood pressure, heart rate, oxygen saturation) 4
- Laboratory results (e.g., troponin I, N-terminal prohormone of brain natriuretic peptide) 3
- Imaging findings (e.g., right ventricular dysfunction on echocardiography) 3
- Patient-specific circumstances (e.g., medical or social reasons for admission) 4
Application of Scoring Tools
The use of these scoring tools can help identify patients with low-risk PE who may be suitable for outpatient management, reducing healthcare costs and minimizing the risk of adverse events 2, 3, 6. For example:
- The HESTIA criteria can discriminate high- from low-risk patients with PE 5
- The PESI score can identify patients with low-risk PE who may be eligible for early discharge 2
- The HESTIA score can be used to select patients for outpatient treatment, with a low risk of recurrent venous thromboembolism, major bleeding, and all-cause mortality 5, 6