TABLE 2.

Clinical criteria for discharging home emergency department patients with acute pulmonary embolism based on absence of high‐risk features

High‐risk features in patients with acute pulmonary embolism	Description
No evidence of hemodynamic instability	During prehospital and emergency department course, include syncope and presyncope a
Negative Hestia clinical decision rule
No high‐risk features on computed tomography pulmonary angiography, if performed	Right ventricle (RV) diameter to left ventricle (LV) diameter ratio >1.0 a
	Main pulmonary artery or saddle PE
	Clot visualized in the heart
No high‐risk features on echocardiogram (bedside or formal), if performed	Right ventricular hypokinesis
	Right ventricular dilatation
	(RV:LV ratio >1.0)
	Bowing of the intraventricular septum
	(ie., D‐sign)
	Clot visualized in the heart
No high‐risk features on laboratory testing	Troponin elevation
No high‐risk features on lower extremity compression ultrasound (bedside or formal), if performed	Deep vein thrombosis in iliofemoral vein
	Evidence of phlegmasia cerulea or alba dolens
No high‐risk features on 12‐lead electrocardiogram a	New right heart strain pattern, including right bundle branch block, deep T‐wave inversions in anterior precordial leads, or S1Q3T3 pattern
	New‐onset atrial fibrillation or flutter

^a If a high‐risk feature is identified, consider echocardiography to evaluate for right heart dysfunction.