Outpatient Treatment of Symptomatic Pulmonary Embolism: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Abstract Abstract 361 Background: Patients with deep vein thrombus (DVT) can safely be treated as outpatients using subcutaneous low molecular weight heparin (LMWH). However the role of outpatient treatment in patients diagnosed with a pulmonary embolism (PE) is controversial. This practice is not accepted in many centers and majority of patients are still admitted to the hospital for observation. Clinicians are reluctant to discharge patients due to insufficient data supporting the safety of outpatient management of PE. Purpose: To determine the safety of outpatient treatment of acute symptomatic PE and the outcomes associated with outpatient management of PE including venous thromboembolism (VTE) recurrence, major bleeding, fatal PE, fatal intracranial hemorrhage (ICH), and overall mortality. Methods: A systematic literature search strategy was conducted using MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and all EBM Reviews of published studies up to June 2012. We included randomized controlled trials (RCTs) and prospective cohort studies. We calculated the pooled proportions for the different outcomes at 3-months of follow-up. Ninety-five percent confidence intervals (95% CI) were calculated for each rate using the averaged, inverse variance-weighted estimates from each study. Results: Thirteen studies met all the inclusion criteria (3 RCTs and 10 prospective cohort studies). A total of 2458 patients were included in the systematic review. Different risk stratification methods were used to identify low risk patients with PE such as the pulmonary embolism severity index (PESI), the Geneva prognostic score, clinical gestalt and/or laboratory markers. The risk of recurrent VTE in patients with PE managed as outpatients was 1.64% (95% CI 0.69 – 3.0%; I2: 70.7%) during the 3 months follow-up period. The rate of fatal PE was 0.70% (95% CI 0.14 – 1. 7%; I2: 72.6%). The rates of major bleeding and ICH were 1.14% (95% CI 0.35 – 2.34%; I2: 72.8%) and 0.29% (95% CI 0.06– 0.68%; I2: 0%), respectively. The overall mortality rate was 2.3% (95% CI 0.41 – 5.7%; I-square: 92.8%). The I2 was moderate to high for most proportions, likely due to difference in the baseline characteristics (e.g. the inclusion of cancer patients in some studies). Conclusion: Independent of the risk stratification methods used, the rate of adverse events associated with outpatient PE treatment seems low. Based on our systematic review and pooled meta-analysis, numerous patients with acute PE can safely be treated as outpatients. Proportion meta-analysis showing the risk of recurrent VTE in patients with PE managed as outpatients for a 3 month follow up period. Disclosures: No relevant conflicts of interest to declare.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.024 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.029 |
| Bibliometrics | 0.005 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".