Summary
Clinical presentation of pulmonary thromboembolism in an emergency department: comparison with previous studies
Affiliation of the authors
DOI
Quote
Martínez Izquierdo MT, Pallás Villaronga O, Clemente Rodríguez C, López Casanova MJ, Aguirre Tejedo A, Echarte Pazos JL. Clinical presentation of pulmonary thromboembolism in an emergency department: comparison with previous studies. Emergencias. 2010;22:113-6
Summary
Objective: To analyze the clinical, electrocardiographic, radiologic, and analytic characteristics
of patients diagnosed with pulmonary thromboembolism and to compare
them with previously published data.
Methods: Retrospective review of the hospital records of patients admitted with a presumptive
diagnosis of pulmonary thromboembolism between January 1, 2004 and December
31, 2006. The data were analyzed using SPSS software, version 14.0.
Results: The diagnosis was confirmed in 83 patients. The patients mean (SD) age was
70.8 (15) years and 18.1% had a prior history of pulmonary thromboembolism or deep
vein thrombosis. Active neoplastic disease was present in 15.7% of cases, a history
of immobilization in 45.8%, chest pain in 31.3%, and syncope in 16.9%. No patient
had hemoptysis. Signs of deep vein thrombosis were noted in 28.9%, venous insufficiency
in the lower limbs in 20.5%, tachypnea in 89.8%, tachycardia in 54.4%, S1Q3T3
in 23.1%, right bundle-branch block in 16.7%, negative precordial T waves in 15.4%,
raised hemidiaphragm in 22.8%, basal atelectasis in 4.8%, pleural effusion in 16.9%,
PaO2 60 mmHg in 30.9%, and PaCO2 35 mmHg in 48.1%. Computed tomography
angiography showed involvement of the central pulmonary vessels in 51.8%
and bilateral and multiple involvement in 45.8%. Overall, 30-day mortality was 7.2%.
Conclusions: Our patients presented characteristics that were different from those of
other published series. They were older, had a higher rate of syncope, absence of hemoptysis,
a low rate of massive pulmonary thromboembolism, and low mortality at 30
days. These data suggest the need for prospective multicenter studies that would allow
us to validate new pretest scales of diagnostic probability for the Spanish population.