The Clinical Impact of the Pulmonary Embolism Severity Index on the Length of Hospital Stay of Patients with Pulmonary Embolism: A Randomized Controlled Trial
Marco Paolo Donadini,
Nicola Mumoli,
Patrizia Fenu,
Fulvio Pomero,
Roberta Re,
Gerardo Palmiero,
Laura Spadafora,
Valeria Mazzi,
Alessandra Grittini,
Lorenza Bertù,
Drahomir Aujesky,
Francesco Dentali,
Walter Ageno,
Alessandro Squizzato
Affiliations
Marco Paolo Donadini
Thrombosis and Haemostasis Center, Ospedale di Circolo, ASST Sette Laghi, 21100 Varese, Italy
Nicola Mumoli
Department of Internal Medicine, Magenta Hospital, 20013 Magenta, Italy
Patrizia Fenu
Presidio Ospedaliero di Cecina, Azienda USL Toscana Nord Ovest, 57023 Cecina, Italy
Fulvio Pomero
Internal Medicine Unit, Michele e Pietro Ferrero Hospital, 12060 Verduno, Italy
Roberta Re
Medicina Interna, Ospedale S. Andrea, ASL Vercelli, 13100 Vercelli, Italy
Gerardo Palmiero
Ospedale Versilia, Azienda USL Toscana Nord Ovest, 55049 Viareggio, Italy
Laura Spadafora
Internal Medicine Unit, Michele e Pietro Ferrero Hospital, 12060 Verduno, Italy
Valeria Mazzi
Presidio Ospedaliero di Livorno, Azienda USL Toscana Nord Ovest, 57124 Livorno, Italy
Alessandra Grittini
Department of Internal Medicine, Magenta Hospital, 20013 Magenta, Italy
Lorenza Bertù
Research Center on Thromboembolic Diseases and Antithrombotic Therapies, University of Insubria, 21100 Varese and 22100 Como, Italy
Drahomir Aujesky
Department of General Internal Medicine, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
Francesco Dentali
Thrombosis and Haemostasis Center, Ospedale di Circolo, ASST Sette Laghi, 21100 Varese, Italy
Walter Ageno
Thrombosis and Haemostasis Center, Ospedale di Circolo, ASST Sette Laghi, 21100 Varese, Italy
Alessandro Squizzato
Research Center on Thromboembolic Diseases and Antithrombotic Therapies, University of Insubria, 21100 Varese and 22100 Como, Italy
Background: The Pulmonary Embolism Severity Index (PESI) is an extensively validated prognostic score, but impact analyses of the PESI on management strategies, outcomes and health care costs are lacking. Our aim was to assess whether the adoption of the PESI for patients admitted to an internal medicine ward has the potential to safely reduce the length of hospital stay (LOS). Methods: We carried out a multicenter randomized controlled trial, enrolling consecutive adult outpatients diagnosed with acute PE and admitted to an internal medicine ward. Within 48 h after diagnosis, the treating physicians were randomized, for every patient, to calculate and report the PESI in the clinical record form on top of the standard of care (experimental arm) or to continue routine clinical practice (standard of care). The ClinicalTrials.gov identifier is NCT03002467. Results: This study was prematurely stopped due to slow recruitment. A total of 118 patients were enrolled at six internal medicine units from 2016 to 2019. The treating physicians were randomized to the use of the PESI for 59 patients or to the standard of care for 59 patients. No difference in the median LOS was found between the experimental arm (8, IQR 6–12) and the standard-of-care arm (8, IQR 6–12) (p = 0.63). A pre-specified secondary analysis showed that the LOS was significantly shorter among the patients who were treated with DOACs (median of 8 days, IQR 5–11) compared to VKAs or heparin (median of 9 days, IQR 7–12) (p = 0.04). Conclusions: The formal calculation of the PESI in the patients already admitted to internal medicine units did not impact the length of hospital stay.
