Safety, efficacy, length of stay and patient satisfaction with outpatient management of low-risk pulmonary embolism patients – a meta-analysis

INTRODUCTION: Annual health expense of hospital admissions, due to venous thromboembolism including pulmonary embolism, exceeds 10 billion dollars in the United States. Most of these patients still get admitted to the hospital despite the advent of novel oral anticoagulants. Our aim is to show that low-risk pulmonary embolism patients can safely be discharged from the emergency department with similar patient satisfaction and lower length of stay. METHODS: A comprehensive search in Medline indexed and non-indexed, Embase, and Cochrane Central was performed to search for all the randomized controlled trials that compared inpatient treatment of low-risk pulmonary embolism to outpatient treatment. RESULTS: Of 68 potentially relevant studies, a total of 2 studies (453 participants) met our inclusion criteria and had data available on patient satisfaction, length of stay, efficacy, and patient safety. The pooled estimate of the included studies showed that at 3-month follow-up, there was no statistically significant difference between inpatient and outpatient treatment of these low-risk patients. CONCLUSIONS: In conclusion, our meta-analysis of 2 randomized controlled trials shows that low-risk pulmonary embolism patients can safely be discharged from the emergency departments in the limited studies available. We need more randomized controlled trials to confirm these findings.