Criteria for home treatment of patients with acute pulmonary embolism (the Emergency Advisory and Research international board on Thrombosis and Hemostasis EARTH - rule): an international Delphi consensus study

Abstract

The safety of home treatment for patients with low-risk acute pulmonary embolism (PE) has been confirmed in several studies; however, these studies have used varying triaging criteria and outcomes, leading to inconsistencies in defining safe discharge parameters. This study aimed to identify adverse outcomes that make home discharge inappropriate, as well as their timeframe and clinical criteria, indicating high risk for such events.

Following a systematic literature review, an international expert panel participated in 3 Delphi survey rounds. Experts evaluated each proposal using a Likert scale, and consensus required 75% agreement. Items without consensus were reassessed in subsequent rounds until agreement was achieved.

Of the 55 invited experts, 38 from 13 countries participated (69%). Consensus was reached on 6 adverse events for a composite outcome, with a 7-day postdischarge timeframe and a maximum acceptable incidence of 2.0%. The panel defined a triaging rule with 14 clinical criteria as contraindications for home treatment, grouped into 4 categories: hemodynamic (3), respiratory (1), hemorrhagic (7), and medico-social (3). An extended rule, adding 3 optional biological or imaging criteria, was developed to further refine risk assessment.

The expert panel established a consensus-based triaging rule for the home treatment of PE patients. This framework defines adverse outcomes, a 7-day safety timeframe, and an acceptable risk threshold for assessing patient safety. Future prospective studies are needed to validate the Emergency Advisory and Research international board on Thrombosis and Hemostasis rule before its implementation in clinical practice.