Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Pulmonary embolism (PE) is often unsuspected by treating clinicians. Since the adoption of clinical prediction scores for PE and the widespread availability of computed tomography (CT)-pulmonary angiogram, there are few reports of clinical presentations of hospitalized patients who died of PE. ⋯ Fatal PE remains a common, unsuspected cause of inpatient death in the modern era. Symptoms of PE, active malignancy, and potentially confounding AV nodal blocking treatment were less frequent in patients with unsuspected PE. These data highlight the variation in presentation and the challenge of making the diagnosis in many hospitalized patients, particularly those without typical symptoms.
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Twenty- to fifty-thousand patients die annually within 72 h of interhospital transfer (early death after transfer; EDAT). The characteristics and trajectories of these patients are ill-defined. In this retrospective cohort study, we characterized EDAT at three representative major referral centers. ⋯ Transfer >50 miles was associated with death ≤24 h after transfer and with posttransfer changes in code status. Further research is needed to evaluate disparities and describe the potential burdens of transfer at end-of-life. Infrequent pretransfer discussions of GOC suggest potential targets for improvement.