Annals of epidemiology · 2026
Incidence and outcomes of emergency medical service treated pulmonary embolism in Victoria, Australia: A population-based cohort study.
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Bloom Jason E, Zilinyi Robert, Mahony Emily, Dawson Luke P, Nehme Emily, Parikh Sahil A, Sethi Sanjum S, Shaw Benjamin, McManamny Tegwyn, Ball Jocasta, Okyere Daniel, Percival Mia A, Anderson David, Dagan Misha, Vasudevan Thodur, Mcfadyen James, Kaye David M, Nehme Ziad, Stub Dion
Аннотация
PURPOSE: Pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. However, population-level data describing the prehospital presentation and outcomes of emergency medical service (EMS)-treated patients remain limited. We aimed to determine the incidence, clinical characteristics, and outcomes of patients with EMS-treated PE in Victoria, Australia.
METHODS: This population-based cohort study included adults attended by a single statewide EMS provider between January 1, 2015, and November 28, 2020, with an in-hospital primary diagnosis of PE. Prehospital electronic patient care records were linked with statewide hospital and death registry datasets. The primary outcome was 30-day all-cause mortality. Multivariable analyses were performed to assess predictors of 30-day mortality.
RESULTS: Among 3,976,574 EMS-attended patients (29.6 million person-years), 6,769 had a confirmed PE, yielding an incidence of 22.9 per 100,000 person-years (95% CI, 22.3-23.4), which increased over the study period from 22.86 in 2015-22.84 per 100,000 person years in 2020 (Ptrend = 0.04). The mean (SD) age was 64.7 (17.3) years. The 30-day mortality was 7.0%, ranging from 0.5% in very low-risk to 19.3% in very high-risk Pulmonary Embolism Severity Index (PESI) categories (P < 0.001). Independent predictors of 30-day mortality included older age, pre-hospital cardiac arrest, pre-existing malignancy, diabetes, and altered vital signs (low systolic blood pressure, hypoxia, and tachypnea). Only 4.2% of patients were discharged directly from the emergency department.
CONCLUSIONS: PE treated by EMS is increasingly common and carries a substantial short-term mortality risk. These findings suggest that established risk stratification tools may help optimize prehospital triage and improve systems of care, however, further dedicated studies are required.
METHODS: This population-based cohort study included adults attended by a single statewide EMS provider between January 1, 2015, and November 28, 2020, with an in-hospital primary diagnosis of PE. Prehospital electronic patient care records were linked with statewide hospital and death registry datasets. The primary outcome was 30-day all-cause mortality. Multivariable analyses were performed to assess predictors of 30-day mortality.
RESULTS: Among 3,976,574 EMS-attended patients (29.6 million person-years), 6,769 had a confirmed PE, yielding an incidence of 22.9 per 100,000 person-years (95% CI, 22.3-23.4), which increased over the study period from 22.86 in 2015-22.84 per 100,000 person years in 2020 (Ptrend = 0.04). The mean (SD) age was 64.7 (17.3) years. The 30-day mortality was 7.0%, ranging from 0.5% in very low-risk to 19.3% in very high-risk Pulmonary Embolism Severity Index (PESI) categories (P < 0.001). Independent predictors of 30-day mortality included older age, pre-hospital cardiac arrest, pre-existing malignancy, diabetes, and altered vital signs (low systolic blood pressure, hypoxia, and tachypnea). Only 4.2% of patients were discharged directly from the emergency department.
CONCLUSIONS: PE treated by EMS is increasingly common and carries a substantial short-term mortality risk. These findings suggest that established risk stratification tools may help optimize prehospital triage and improve systems of care, however, further dedicated studies are required.