Zondag et al identified a number of criteria associated with risk of early mortality in patients with acute pulmonary embolism. These patients should receive care in the hospital. The criteria were developed by multiple hospitals in The Netherlands participating in the Hestia Study.
Patient selection: acute pulmonary embolism
Criteria - one or more of the following:
(1) hemodynamically unstable (systolic blood pressure < 100 mm Hg, heart rate > 100 beats per minute, admission to ICU, etc)
(2) thrombolysis or embolectomy necessary
(3) high risk of bleeding (gastrointestinal bleeding in past 14 days, stroke within past 28 days, surgery within past 14 days, bleeding disorder, thrombocytopenia, uncontrolled hypertension)
(4) oxygen therapy required to maintain oxygen saturation > 90% for > 24 hours
(5) pulmonary embolism while receiving anticoagulation therapy
(6) intravenous pain medication > 24 hours
(7) medical or social reason to treat in the hospital > 24 hours
(8) creatinine clearance < 30 mL per minute (using the Cockroft-Gault formula)
(9) severe liver impairment
(10) pregnancy
(11) documented history of heparin-induced thrombocytopenia
Interpretation:
• minimum number of criteria: 0
• maximum number of criteria: 11
• If one or more criteria are present, then the patient cannot be treated at home.
• A patient with no criteria met is at low risk of early mortality
