Out Patient (Ambulatory) Management

Traditionally patients with suspected or proven PE have been admitted to hospital and anticoagulated. However, it is now accepted that in young, fit patients with normal saturations, pulse rate and no signs of right heart strain outpatient investigation and anticoagulation is a safe alternative.

The Pulmonary Embolism Severity Index (PESI)25 and a simplified version of PESI26 have been used to decide which patients may be suitable for outpatient or ambulatory care. Some departments are now using such scores as the basis for ambulatory care pathways for patients with suspected PE. Thus, patients with a Simplified PESI Score of zero are considered at low enough risk to treat as outpatients. NICE guidelines14 suggest that outpatient treatment can be considered for low risk patients.

Original and simplified PESI