CONGRESS ABSTRACT

INTRODUCTION: Pulmonary embolism (PE) is associated with high mortality when not promptly diagnosed and adequately treated. The often nonspecific clinical presentation is responsible for the diagnostic difficulty and the frequent finding of PE at autopsy. MATERIALS & METHODS: Since 2022, we have implemented an in-hospital management pathway based on the multidisciplinary assessment of patients arriving in the of patients arriving in the Emergency Department (ED) and the integration of clinical suspicion with first-level diagnostic tests (ECG, ABG, chest X-ray, blood tests) and clinical pre-test probability (modified Wells, Geneva). Patients with a Wells score of 0 to 4 and a negative D-dimer are excluded from the diagnosis of PE; in other cases, CT pulmonary angiography is performed. The integration of the diagnostic data thus obtained with the troponin dosage (sPESI Score) and the echocardiogram are used in patients diagnosed with high-risk PE for prognostic stratification and to identify the destination of hospitalization. RESULTS: Comparing hospital admissions for PE between 2021 and 2023 allowed us to verify how, thanks to the in-hospital shared management pathway, a different distribution of admissions was achieved in the Operating Units involved: admissions to Cardiology decreased by 50%; conversely, admissions to Internal Medicine increased by 60% in 2022, remaining stable in 2023. In 2024 and 2025, out of 64 patients diagnosed with PE in the ED, 25 were admitted to Cardiology and 38 to Medicine wards; 1 patient was admitted to Cardiac Surgery. Admissions to other departments of the Hospital for patients with other major prevalent comorbidities increased from 3% to 7%. CONCLUSIONS: These results justified and rewarded the effort to organize multidisciplinary management of the patient admitted to the emergency department. It was possible to ensure the correct diagnostic assessment and timely treatment, but above all, to identify the risk class and the most appropriate hospitalization setting.