Project Summary/Abstract Our long-range goal is to improve the quality and safety of care provided to patients presenting to emergency departments nationwide with pulmonary embolism, resulting in improved health outcomes for this patient population. The objective of this application is to compare right ventricular dysfunction dependent and independent prognostic models for short-term serious adverse events in pulmonary embolism patients. We have initiated a pilot study at Carolinas Medical Center and will be working with six other academic emergency medicine departments participating in the Pulmonary Embolism Short-term Clinical Outcomes Registry. The target population will be emergency department (ED) patients with confirmed acute pulmonary embolism (PE) within 12 hours of ED presentation. The overall goal of the registry is to optimize risk stratification of ED patients with acute PE to identify patient need for hospital- based monitoring and interventions within five days of PE diagnosis. The primary outcome will be a composite of death, delayed circulatory or respiratory dysfunction, hypoxia, and reperfusion intervention within five days of PE diagnosis. Secondary outcomes will be nonfatal bleeding, recurrence of venous thromboembolism, and hypoxia requiring oxygen supplementation. Specific aims are: 1) determine the incidence of death, circulatory and respiratory deterioration, and administration of reperfusion therapy within five days of PE; 2) determine functional outcomes 30 days after PE using the Pulmonary Embolism Quality of Life questionnaire; 3) evaluate the sensitivity, specificity, and positive and negative likelihood ratios of each RVD assessment tool for clinical deterioration within five days of PE; and 4) derive a prediction model for clinical deterioration within five days of PE diagnosis. Our proposed research addresses AHRQ priority areas 1 and 2. By achieving the proposed aims, we will improve early identification of PE severity and empower healthcare professionals and patients to make informed, time-sensitive decisions based on need for hospital-based support and monitoring following PE diagnosis.