@movinmeat There was a recent study about DC with PEs that couldn't support sending home. Based on what I see, I still admit all
@EMManchester @EMDocBrett @movinmeat A few studies support it for low risk/small/NL VS. Needs institutional support as most still admit.- @BobStuntz @EMManchester @EMDocBrett @movinmeat Hestia study: 1.usa.gov/SRmYn7. Lancet study: output non-inferior: 1.usa.gov/UINaWA
@EMDocBrett @movinmeat @thegreathornero Normal practice in UK to discharge on LMWH awaiting CTPA/VQ scan ncbi.nlm.nih.gov/pmc/articles/p…- @BobStuntz @EMManchester @movinmeat The PESI 1 w/ bilat PEs & has chest pain, not sure I'd send home. I think clin judgment still prevails
- @EMDocBrett @Akutdok @movinmeat My Q is can ???low/mod-PE??? be discharged on LMWH awaiting out patient CTPA Answer- YES in UK practice.
@AlSomali @emmanchester @emdocbrett @akutdok It seems clear there's a subset of pts who could safely go home. How to identify them is the Q.
@movinmeat @emdocbrett @emeducation @emmanchester Evidence to support d/c from ED ncbi.nlm.nih.gov/pubmed/21703676 and ncbi.nlm.nih.gov.proxy.kib.ki.se/pubmed/23100493- @Akutdok @movinmeat @EMDocBrett @EMEducation And also in NICE Guidance here pathways.nice.org.uk/pathways/venou…
- @Akutdok @alsomali @emmanchester @emdocbrett PESI + judgement (i.e. size/location of clot, subjective total clot burden) may work.
- @EMDocBrett @emmanchester @movinmeat read hestia study I posted. They propose criteria. Like I said, small pe, healthy pt, NL vital prob ok
- @BobStuntz @emdocbrett @emmanchester Those were good refs. I think we are going this way but ER culture is very risk averse, esp w PE
- @EMManchester @bobstuntz @emdocbrett @movinmeat That's the point I was trying to make. Many dvt pats probably have small PEs w/o symptoms.
- @Akutdok @emmanchester @emdocbrett @movinmeat to do this in US, need institutional accepted protocol (2/2 medicolegal risk) + v lo risk pt
- @Akutdok @emmanchester @emdocbrett @movinmeat part of our problem is we diagnose too many PEs, another matter entirely
@akutdok @emmanchester @bobstuntz @emdocbrett @movinmeat Plus is the only study comparing anticoagulation vs nothing: no benefit from Rx- @EMDocBrett @bobstuntz @emmanchester @movinmeat Any evidence that involving lawyers in your health care system improves outcomes?
- @Akutdok @emdocbrett @bobstuntz @emmanchester NO, and probably exposes patients to iatrogenic harm in addition to bankrupting the country.
@EMManchester @movinmeat @bobstuntz @emdocbrett also see this in a recent JTH europepmc.org/abstract/MED/2…. Sums it up nicely I think.- @thegreathornero @emmanchester @movinmeat @bobstuntz @emdocbrett whoops - meant this link onlinelibrary.wiley.com/doi/10.1111/j.… for last post. Convinced?
BobStuntz
EM Res
EUS fellowship trained Emergency Physician with an interest in resident education, ultrasound, and #FOAMed
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