Clinical outcome of patients with suspected pulmonary embolism. A follow‐up study of 588 consecutive patients

Abstract

Objective. To investigate the clinical outcome in patients with clinically suspected pulmonary embolism (PE). Design and setting. In a retrospective design we studied 588 consecutive patients with suspected PE and referred for lung scintigraphy from 1995 to 1998. The mean follow-up time was 653 424 days. Results. The diagnosis of PE was con®rmed in 194 and excluded in 394 patients, respectively. The overall prevalence of PE was 33%. Amongst clinical and paraclinical variables, age, chronic obstructive pulmonary disease (COPD), heart rate, pleuretic pain, presence of deep venous thrombosis (DVT), electrocardiographic signs of right ventricular (RV) strain were identi®ed as independent predictors of the diagnosis of PE. Amongst patients with PE anticoagulation was given in 96% for at least 3 months and 13% received thrombolytic therapy. Recurrent PE was seen in 6% of patients with PE whereas none of the patients with no diagnosis of PE suffered PE during follow-up. The 1 year mortality was 18% amongst patients with PE and 15% in patients with excluded PE (P NS). The cause of death amongst patients with PE was cancer (49%) and PE (28%), whereas patients without PE had an excess mortality because of cancer, COPD, acute myocardial infarction and heart failure. Conclusion. Patients admitted to hospital on suspicion of PE have increased risk of adverse clinical outcome whether the diagnosis of PE is con®rmed or not. This indicates that the patients where the diagnosis is excluded often suffer from other serious illness that warrants further investigations.

Chronic obstructive pulmonary disease and deep vein thrombosis: a prevalent combination

“…The treatment plan of COPD patients more often included IVC filter insertion. Poulsen et al showed that COPD is an independent risk factor for PE [10]. The Christopher Study Group showed an 18% prevalence of PE in 341 patients with COPD [3].…”

Should pulmonary embolism be suspected in exacerbation of chronic obstructive pulmonary disease?

“…7 On the other hand, COPD is often cited among the risk factors for acute venous thromboembolism and was recently identified as an independent predictor of pulmonary embolism. 9 In a small series of patients, the prevalence of deep vein thrombosis in patients admitted with acute exacerbation of COPD was 31%. 10 11 Similarly, on the basis of ventilationperfusion lung scintigraphy, the prevalence of pulmonary embolism in patients admitted with acute exacerbation of COPD was as high as 20%.…”

Prognostic significance of the lung scintigraphy scan result and corresponding chest X-ray in patients with suspected pulmonary embolism

“…A study by Hvitfeldt Poulsen et al showed that among patients with suspected PE the one-year all-cause mortality for patients with PE confirmed by imaging was not significantly different from that in patients for whom PE was refuted by imaging (18% and 15% respectively). 10 A separate study found a six-month all-cause mortality of 18% for patients who had an intermediate probability lung scan, very few of the deaths being attributable to PE.…”