Racial and gender disparities in the management of acute pulmonary embolism.

OBJECTIVE: The aim of this study was to assess race and sex disparities in use and outcomes of various interventions in patient with acute pulmonary embolism (PE). METHODS: We included 129,445 patients with acute PE from the NIS from January 2016 to December 2019. Rates of inferior vena cava (IVC) filter placement, catheter-directed thrombolysis (CDT), CDT with ultrasound, systemic thrombolysis, surgical embolectomy, percutaneous thrombectomy, extracorporeal membrane oxygenation, and mechanical ventilation were compared between race and sex subgroups, along with length of hospital stay, major bleeding events, mortality, and other adverse events. Multivariate linear regression analysis was used to adjust for variables that were significantly different between race and sex, including demographic factors, comorbidities, socioeconomic factors, and hospital characteristics. RESULTS: Compared with White male patients, all subgroups had significantly higher odds of in-hospital mortality highest in Hispanic male patients (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.090-1.640; P < .01). All subgroups also had a higher odds of major bleeding events and increased length of stay. All subgroups also had lower odds of receiving CDT, lowest in Black female patients (OR, 0.740; 95% CI, 0.660-0.820; P < .001) and Hispanic female patients (0.780; 95% CI, 0.650-0.940; P < .001) compared with White male patients. There was no significant difference in the use of systemic thrombolysis among subgroups. CONCLUSIONS: Black and Hispanic patients and female patients are less likely to undergo CDT compared with White male patients, in addition to having higher odds of mortality, major bleeding, and increased length of stay after management of PE. Further efforts are needed to mitigate disparate outcomes of PE management at not only an institutional, but at a national, level to promote health care equality.

Trueperella pyogenes pharyngitis in an immunocompetent 40-year-old man.

A 40-year-old man presented to his primary care physician with a constellation of systemic symptoms and new biofilm forming along his upper airway. He had brought home a deer 10 days prior from a day of hunting, and discovered green purulent material oozing from the entrance/exit wounds. The patient smokes cigarettes and did not use any protective equipment or wash his hands between dressing the deer and smoking. Several days following exposure, he became increasingly short of breath, fatigued, constipated and developed a cough productive of orange sputum. Speaking with state wildlife biologists led to the diagnosis of a zoonotic Trueperella pyogenes infection. Initial treatment with broad spectrum antibiotics was ineffective in resolving the infection. An infectious disease appointment was made, but the patient's infection resolved with the use of a veterinarian antibiotic taken under physician's supervision.