403 Management of Emergency Department Patients With Low-Risk Deep Vein Thrombosis in the United States

Document Type

Conference Proceeding

Publication Date

9-1-2025

Publication Title

Ann Emerg Med

Abstract

Study Objective: Historically, patients diagnosed with deep vein thrombosis (DVTs) were admitted for anticoagulation. In 2024, the American College of Emergency Physicians (ACEP) introduced a quality measure to encourage discharging patients with low-risk DVTs as part of the Merit-Based Incentive Payment System (MIPS). Patients with high-risk factors such as proximal DVT, concurrent PE, syncope, or those already on anticoagulation are excluded from the measure. The aim of our study is to evaluate retrospective adherence with ACEP’s new DVT MIPS measure. Methods: Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2016-2022 was analyzed, which contained ED visit information representing 1,867,690 patients diagnosed with DVT (ICD-10 codes: I82.4, I82.6, I82.5, I82.B). Bivariate and multivariable analyses examined associations between demographic factors, clinical characteristics (including DVT risk type and comorbidities), and disposition (admission versus discharge). Statistical tests used included Weighted Welch's T-Test and Rao-Scott Chi-Square Test. Results: Overall, 81.5% of patients were considered low-risk (95% CI, 73.9-87.3%). There was a significant difference in ED disposition by MIPS risk-type with 68.4% of low-risk patients being discharged (95% CI, 58.9-76.6%) compared to only 34.8% of high-risk patients being discharged (95% CI, 17.8-56.9%; p=0.005). Of the exclusion criteria in the MIPS measure, only concurrent PE was independently associated with admission (23.7% [95%CI 14-37%] admitted patients versus 3.17% [95% CI 0.71-13%] discharged patients, p=0.002), like due to infrequent reporting of other exclusion criteria. Additionally, we found several other factors associated with admission that are not currently built into the MIPS measure, such non-syncope other diagnoses associated with hemodynamic instability (hypotension [p <0.001], acute hypoxic respiratory failure [p=0.016]), composite risk of bleeding (p=0.007), acute blood loss anemia (p=0.033), and other comorbidities such as CKD/ESRD (p=0.008) and Alzeheimer’s/dementia (p=0.003). Conclusions: Based on our study, opportunities exist to increase adherence with this measure. Additionally, opportunities exist to modify the measure to add additional exclusions for hemodynamic instability, risk of bleeding, or other comorbidities. No, authors do not have interests to disclose

Volume

86

Issue

3

First Page

S175

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