ORIGINAL: How to Improve the Clinical Suspicion of Pulmonary Embolism in Hospitalized Patients
DOI:
https://doi.org/10.12970/2311-052X.2016.04.02.5Keywords:
Pulmonary embolism, clinical suspicion, anxiety, sudden dyspnea.Abstract
Background: The high number of missed diagnosis of pulmonary embolism antemortem still has not improved.
Objective: To define the causes of misdiagnosis and suggest another way in order to increase the rate of clinical suspicion.
Material and Methods: The cases with autopsy-confirmed of PE from 32986 autopsies were studied retrospectively. The data was classified according to the useful points to investigate the causes of undiagnosed antemorten.
Results: The number of patients that had the diagnosis suspected of PE antemorten was 692 (24.2 %). The dominant cause of misdiagnosis was deficient clinical suspicion (26.4 %). The underlying conditions that most frequently cause unsuspected PE were heart disease 24.6 % (mainly myocardial infarction), pneumonia (23 %) and cancer (15.1 %). Altogether, the percentage of correct clinical diagnosis of PE was 26.9 % (95 % CI).
Conclusions: To increase the rate of correct diagnosis of PE, it is necessary to perform the clinical suspicion in the atypical forms that are common, besides the classical markes used.
References
Walden R, Bass A et al. Pulmonary embolism post-morten material with clinical correlation in 425 cases. Inst Angiol 1985; 4(4): 263-73.
Spitiopolus C, Papadolimas A, et al. Clinical diagnosis and autopsy findings: a retrospective analysis of 252 cases in Greece. Arch Pathol Lab Med 2005; 129(2).
Laack TA, Goyal DG, Pulmonary embolism: an unsuspected killer. Emergency Medicine Clinics of America 2004; 22: 961-983. http://dx.doi.org/10.1016/j.emc.2004.05.011
Sweet PH III, Amstrong T, Chen J, et al. Fatal pulmonary embolism update: ten years of autopsy experience at an at Academic Medical Center. J Royal Soc Med 2013; 4(9). http://dx.doi.org/10.1177/2042533313489824
Pineda A, Hathwar VF, Grant BJ. Cljnical suspicion of fatal pulmonary. Embo Ism Chest 2001; 120: 791-795. http://dx.doi.org/10.1378/chest.120.3.791
Stein PD, Beemath A, Matta F, et al. Clinical characteristics of patients with acute pulmonary embolism. Data from PIOPED II. The Am Jr of Med 2007; 120: 871-879. http://dx.doi.org/10.1016/j.amjmed.2007.03.024
Bulbul Y, Ozsu S, Kosuko P, et al. Time delay between onset of symptoms and diagnosis of pulmonary embolism 2009; 78: 96-41. (Abstract) Turkey.
Krawinski B, Svendsen E. Comparison of clinical and postmortem diagnosis of pulmonary embolism. J Clin Pathol 1989; 42: 135-139. http://dx.doi.org/10.1136/jcp.42.2.135
Pulido T, Aranda A, Zeballos, et al. Pulmon ary embolism as a cause of death in patients with heart disease: an autopsy study. Chest 2006; 129(5): 1882-7. http://dx.doi.org/10.1378/chest.129.5.1282
Mandelli V, Schmid C, Zognd C, et al. False negative and false positive in acute pulmonary embolism. Clinico-Postmorten Comparison 1997; 4292: 205-10.
Rubinstein I, Murray D, Hofftein V. Fatal pulmonary embolism in hospitalized patients: an autopsy study. Arch Intern Med 1988; 148(6): 1425-26. http://dx.doi.org/10.1001/archinte.1988.00380060189033
Brevetti GR, O’Brien B, Coomer. Emergent surgery for massive pulmonary emblism the basis of clinical diagnosis alone. Tex Heart Inst 2003; 30 (2): 149-151.
Elliot CG, Goldhaber SZ, Jense PI. Delay in diagnosis of deep venous thrombosis and pulmonary embolism. Chest 2005; 128 (5): 3372-6. http://dx.doi.org/10.1378/chest.128.5.3372
Aquino W, Agnelli G, I mbarti D, et al. Factors associated with th timing of diagnosis of venous thromboembolism: results from fhe MASTER registry. Thronb Res 2008; 121(6): 751-6. http://dx.doi.org/10.1016/j.thromres.2007.08.009
Rosen MP, Sanz, et al. Does a physician ability to accurate assess the likelihood of pulmonary embolism with training? Academic Med 2000; 175(12): 7190.
Van Danzig IM. Echocardiography in the Emergency Room. Semn Cardio-thorax Vasc Anesth 2000; 10(1): 79-81. http://dx.doi.org/10.1177/108925320601000114
Konstantinides S. Diagnosis and therapy of pulmonary embolism. VASA 2006; 5(3): 136-45.
Sanchez O, Trinquart I, Colombet S, et al. Prognostic value of right ventricular dysfunction in patients haemodynamically stable pulmonary embolism: systemic review. Eur Heart J 2008; 29(12): 1569-77. http://dx.doi.org/10.1093/eurheartj/ehn208
Stein PD, Woodward Weg JG, et al. Diagnotic pathway in pulmonary embolism: recommendation of the PIOPD investigators. Am J of Med 2006; 119(12). http://dx.doi.org/10.1016/j.amjmed.2006.05.060
