Fatal pulmonary embolism in hospitalized patients. Clinical diagnosis versus pathological confirmation

Abstract

Objective -To assess the incidence of fatal pulmonary embolism (FPE), the accuracy of clinical diagnosis, and the profile of patients who suffered an FPE in a tertiary University Hospital. Methods -Analysis of the records of 3,890 autopsies performed at the Department of General Pathology from January 1980 to December 1990. Results -The scarcity of Brazilian statistics makes us resort to using figures obtained from other countries in order to assess the magnitude of health problems in Brazil. Pulmonary embolism represents one of the best examples of the need for epidemiological investigation in our population.According to the most frequent estimates, pulmonary embolism accounts for 300 thousand hospitalizations and 50 thousand deaths annually in the United States of America 1 . In these studies conducted in the 50's, pulmonary embolism accounted for 3% of the deaths and was a contributing factor to 6% of all deaths. More recent investigations, such as the studies conducted by Morrel and Dunnill, have reported much higher incidences. According to these authors, pulmonary embolism alone accounts for 7% of adult deaths in general hospitals 2 .Autopsy studies have shown that approximately 40% to 60% of the individuals who die as a result of pulmonary embolism are not diagnosed with this condition when alive 3,4 . Approximately 10% of all patients with pulmonary embolism die within the first hour of symptom onset, precluding the use of more sophisticated diagnostic methods. In those who survive after the first hour, the prognosis is closely related to a correct diagnosis and therapy. Mortality is 5 to 6 times higher in those individuals who are not properly diagnosed and in whom the therapy is not instituted 5 .The significance of the figures mentioned above underscores the importance of recognizing the clinical features, the predisposing conditions and the natural history of this disease.We conducted a case-control study at the Department of Pathology of a university hospital to assess the incidence and the accuracy of the clinical diagnosis and the profile of the patients who suffered a fatal pulmonary embolism (FPE). MethodsWe reviewed the records of all autopsies performed on

Pulmonary thromboembolism in an East African tertiary referral hospital

“…This implies that as the Kenyan population ages, the incidence of PTE is likely to increase unless prudent control measures are instituted. Although male gender is sometimes regarded a risk factor for PTE [13], the slight female predominance observed in the present study is concordant with literature reports [17][18][19]. It is notable that some studies have reported 1:1 ratio [20].…”

Diagnosing pulmonary embolism: A question of too much choice?

“…In my own institution a recent review of 400 cases revealed that fewer than 50% of cases had a definitive diagnosis made after an initial test for PE. Over three decades the diagnosis was consistently missed clinically in up to 70% of patients who died of PE 7–10 …”

“…The reduction in numbers of post mortems performed in modern practice handicaps many follow up studies. We know 70% of PEs are missed premortem in the hospital setting 9,10,38 . Studies that presume death is not due to PE on the basis of clinical diagnosis and not post mortem results are clearly flawed.…”

Fisiopatologia do tromboembolismo pulmonar

“…Existem poucos dados disponíveis sobre a incidência de tromboembolismo pulmonar no Brasil. Estudos nacionais mostram que, em cerca de 3% a 5% das necropsias, verifica-se a presença de tromboembolismo, e em 68% destes casos a condição foi considerada como causa do óbito 9,10 . O número de hospitalizações por embolia pulmonar, no Brasil, aproximou-se de 6.700 casos, em 2004, segundo dados do DATASUS 11 .…”

“…O número de hospitalizações por embolia pulmonar, no Brasil, aproximou-se de 6.700 casos, em 2004, segundo dados do DATASUS 11 . Entretanto, estima-se que 75% dos casos não são diagnosticados 10 .…”