According to this study:

* A hospital stay of more than four days led to higher 30-day postdischarge mortality in patients with pulmonary embolism.

In a study conducted in hospitals in Pennsylvania, researchers found that patients with pulmonary embolism with a length of stay of four days or less had a significantly higher postdischarge mortality rate than those hospitalized for five to eight days, "suggesting that physicians may inappropriately select patients with pulmonary embolism [horizontal ellipsis] for early discharge who are at increased risk" for complications.

The study involved 15,531 patients diagnosed with pulmonary embolism from 186 hospitals across the state of Pennsylvania. The median length of stay at all hospitals was six days. Data on demographics, insurance, hospital size, and length of stay were obtained from a state database over 23 months. These data were linked with details on each patient's clinical presentation in another database. Using the Pulmonary Embolism Severity Index (PESI) model, researchers determined the severity of the patient's illness, assigning it a rating from I to V. The study's primary finding regarding early discharge and high mortality was particularly notable given that more than half of the patients who were discharged at four days or earlier were given PESI risk ratings of III to V.

Postdischarge mortality was also lower in patients who had received thrombolytics while hospitalized, compared with those who did not. Additionally, after adjustment for hospital and patient differences, mortality significantly climbed as PESI risk ratings increased, with patients rated as V having a much higher mortality rate than patients rated as I.

The study's results underscore the need for appropriate management of patients with pulmonary embolism, especially those with a higher severity of illness, and for hospitals to consider incorporation of stricter discharge protocols.

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Aujesky, D, et al. Arch Intern Med. 2008; 168(7):706-12