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Título: | Randomised controlled trial of a prognostic assessment and management pathway to reduce the length of hospital stay in normotensive patients with acute pulmonary embolism |
Autor: | Jiménez, David CSIC ORCID; Rodríguez, Carmen CSIC ORCID ; León, Francisco CSIC ORCID; Jara Palomares, Luis CSIC ORCID; López-Reyes, Raquel; Ruiz-Artacho, Pedro; Elías-Hernández, Teresa CSIC ORCID; Otero Candelera, Remedios CSIC ORCID; García-Ortega, Alberto; Rivas-Guerrero, Agustina; Abelaira, Jaime; Jiménez, Sonia CSIC; Muriel, Alfonso; Morillo-Guerrero, Raquel; Barrios, Deisy; Le Mao, Raphael; Yusen, Roger D.; Bikdeli, Behnood; Monreal, Manuel; Lobo, José Luis | Fecha de publicación: | feb-2022 | Editor: | European Respiratory Society | Citación: | European Respiratory Journal 59: 2100412 (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. |
Versión del editor: | https://doi.org/10.1183/13993003.00412-2021 | URI: | http://hdl.handle.net/10261/306990 | DOI: | 10.1183/13993003.00412-2021 | ISSN: | 0903-1936 |
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