• Joseph R Bledsoe, Scott C Woller, Scott M Stevens, Valerie Aston, Rich Patten, Todd Allen, Benjamin D Horne, Lydia Dong, James Lloyd, Greg Snow, Troy Madsen, Patrick Fink, and C Gregory Elliott.
• The Department of Emergency Medicine, Stanford University-Intermountain Healthcare Delivery Institute, Salt Lake City, UT, United States of America. Electronic address: drjbledsoe@gmail.com.
• Am J Emerg Med. 2021 Mar 1; 41: 80-83.

ObjectiveEvaluate the cost-effectiveness and difference in length-of-stay when patients in the ED diagnosed with low-risk pulmonary embolism (PE) are managed with early discharge or observation.MethodsSingle cohort prospective management study from January 2013 to October 2016 of patients with PE diagnosed in the ED and evaluated for a primary composite endpoint of mortality, recurrent venous thromboembolism, and/or major bleeding event at 90 days. Low-risk patients had a PE Severity Index score < 86, no evidence of proximal deep vein thrombosis on venous compression ultrasonography of both lower extremities, and no evidence of right heart strain on echocardiography. Patients were managed either in the ED or in the hospital on observation status. Primary outcomes were total length of stay, total encounter costs, and 30-day costs.Results213 patients were enrolled. 13 were excluded per the study protocol. Of the remaining 200, 122 were managed with emergency department observation (EDO) and 78 with hospital observation (HO). One patient managed with EDO met the composite outcome due to a major bleeding event on day 61. The mean length of stay for EDO was 793.4 min (SD -169.7, 95% CI:762-823) and for HO was 1170 (SD -211.4, 95% CI:1122-1218) with a difference of 376.8 (95% CI: 430-323, p < 0.0001). Total encounter mean costs for EDO were $1982.95 and $2759.59 for HO, with a difference of $776.64 (95% CI: 972-480, p > 0.0001). 30-day total mean costs for EDO were $2864.14 and $3441.52 for HO, with a difference of $577.38 (95% CI: -1372-217, p = 0.15).ConclusionsPatients with low-risk PE managed with ED-based observation have a shorter length of stay and lower total encounter costs than patients managed with Hospital-based observation.Copyright © 2020 Elsevier Inc. All rights reserved.

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