{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T15:58:40Z","timestamp":1791388720307,"version":"4.3.3"},"reference-count":17,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Current pulmonary embolism (PE) guidelines support outpatient management for selected low\u2010risk patients, typically identified using the simplified Pulmonary Embolism Severity Index (sPESI). The prognostic value of individual sPESI scores in the direct oral anticoagulant (DOAC) era, particularly when combined with cardiac biomarker assessment, remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research Question<\/jats:title>\n                    <jats:p>To evaluate 7\u2010day and 30\u2010day all\u2010cause mortality among patients with acute PE, sPESI scores of 2 or 3, and negative cardiac biomarkers treated with a DOAC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design and Methods<\/jats:title>\n                    <jats:p>Retrospective cohort study of US adults diagnosed with acute PE in a VA emergency department and prescribed a DOAC within 24\u2009h of diagnosis at any U.S. Veterans Affairs (VA) Health System from 2015 to 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Seven\u2010day and 30\u2010day all\u2010cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 6427 eligible patients, 1365 had an sPESI score of 2 and 455 had an sPESI score of 3 with negative cardiac biomarkers. In the sPESI 2 cohort, 7\u2010day and 30\u2010day mortality were 0.44% and 1.39%, respectively. In the sPESI 3 cohort, rates were 0.22% and 2.20%. Approximately 71% of sPESI 2 patients and 75% of sPESI 3 patients were hospitalized. Hospitalization was not associated with lower 7\u2010day or 30\u2010day mortality in either cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Patients with acute PE, sPESI scores of 2 or 3, and negative cardiac biomarkers had low short\u2010term mortality in this large, contemporary DOAC\u2010treated cohort. These findings support prospective studies evaluating outpatient management in carefully selected patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.70425","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T15:48:57Z","timestamp":1791388137000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk Stratification of Acute Pulmonary Embolism: Outcomes in Patients With Intermediate\n                    <scp>sPESI<\/scp>\n                    Scores and Negative Cardiac Biomarkers"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9074-9872","authenticated-orcid":false,"given":"Michael","family":"Dore","sequence":"first","affiliation":[{"name":"Durham Veterans Affairs Medical Center  Durham North Carolina USA"},{"name":"Duke University School of Medicine  Durham North Carolina 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