Outpatient Care of Pregnant Patients With Acute Pulmonary Embolism in 21 United States Community Hospitals

Most studies on the safety and effectiveness of outpatient PE care (defined here as discharge home within 24h of arrival) have systematically excluded pregnant patients. We address this knowledge gap by describing the prevalence of outpatient care, practice patterns, and 7-day safety outcomes.

This retrospective cohort study was conducted across 21 U.S. community emergency departments (EDs) over 14 years (2011-2024). We included adults known to be pregnant with PE-related symptoms and a primary diagnosis of PE via pulmonary vascular imaging in the ED or labor and delivery unit (LDU). We excluded those who died within 24h before disposition decision-making. We distinguish ED/LDU only care from transferal to another service or location. Outcomes included 7-day PE-related hospitalization and all-cause mortality. We used descriptive statistics.

Of 75 gravid patients with PE, 1 was excluded for early death. Among the remaining 74, 24 (32%) were treated as outpatients (22 diagnosed in the ED and 2 in the LDU). Eight were in the third trimester. PEs were located in main (n=2), lobar (n=1), segmental (n=16), subsegmental (n=3), and unknown (n=2) pulmonary arteries. All were hemodynamically stable and most had normal pregnancy-adapted vital signs at discharge. The 1 patient with abnormal respiratory rate and oxygen saturation was discharged on oxygen. All were treated with enoxaparin. Ten were discharged home directly from the ED (n=9) or LDU (n=1) after a mean stay of 6.9h. Obstetrics or hospital medicine was consulted for all. The other 14 were transferred for observation before discharge home (mean total stay of 19.6h). Echocardiography was obtained for 3 patients (all transferred), with right ventricular dysfunction in 1, who was stable on discharge. Follow-up occurred on average within 6.3 days and within 14 days for 21. Two had 7-day PE-related hospitalizations: 1 for pain needing intravenous analgesia and 1 for enoxaparin allergy. There were no deaths.

One-third of gravid ambulatory adults with acute PE in this community setting were discharged home within 24h. Care was multidisciplinary and often included service or location transfer. Seven-day PE-related hospitalizations were uncommon. Outpatient care of ambulatory PE patients appears feasible and safe but studies of larger cohorts in other settings are needed to better understand this understudied practice.