Sweet Patrick H, Armstrong Theodore, Chen John, Masliah Eliezer, Witucki Peter
Department of Pathology, University of California San Diego, San Diego, CA, USA.
JRSM Short Rep. 2013 Jul 30;4(9):2042533313489824. doi: 10.1177/2042533313489824. eCollection 2013.
To investigate the rate of death caused by pulmonary embolism (PE) and the antemortem performance in diagnosis and treatment of PE.
A systematic search of cases involving fatal PE via PowerPath® (Sunquest) followed by chart review.
An academic medical centre located in San Diego, United States of America.
Postmortem cases with pathological findings of PE.
After data collection and collation, the data were subject to analysis.
From 2002 to 2012, PE was identified as the mechanism of death in 108 of 982 cases (11%, 95% CI 9.01-12.99%) at an institution with an average autopsy rate of 30% ± 0.07%. Excluding cases where care was withheld (by advance directive) or unavailable, 29 of 108 were eligible for antemortem treatment for PE. In 31% (nine of 29) of these cases the diagnosis of PE was considered antemortem. Only three of 29 were given thrombolytics despite only one case being contraindicated.
The rate of PE-related death is consistent with most other autopsy series and major epidemiologic studies despite advances in system wide deep venous thrombosis prophylaxis. The results validate previous studies that this diagnosis is often missed but probably improving compared to historical standards. Even when the diagnosis is considered, however, thrombolytics are not routinely given, even without contraindications. The cause of this failure to treat may require further study with comparison to patients that were treated to determine the utilization of this treatment. It also underscores the continued difficulty in the diagnosis of this disease.
调查肺栓塞（PE）所致死亡率以及PE生前诊断与治疗情况。
通过PowerPath®（Sunquest）系统检索致命性PE病例，随后进行病历审查。
位于美国圣地亚哥的一家学术医疗中心。
具有PE病理检查结果的尸检病例。
数据收集与整理后进行分析。
2002年至2012年期间，在一家平均尸检率为30%±0.07%的机构中，982例病例中有108例（11%，95%CI 9.01 - 12.99%）被确定PE为死亡原因。排除因预先指示而放弃治疗或无法获得治疗的病例后，108例中有29例符合PE生前治疗条件。在这些病例中，31%（29例中的9例）的PE诊断被认为是生前做出的。29例中只有3例接受了溶栓治疗，尽管只有1例有禁忌证。
尽管在全系统预防深静脉血栓形成方面取得了进展，但PE相关死亡率与大多数其他尸检系列和主要流行病学研究结果一致。结果证实了先前的研究，即该诊断常常被漏诊，但与历史标准相比可能有所改善。然而，即使考虑到该诊断，即使没有禁忌证，溶栓治疗也未常规使用。未能进行治疗的原因可能需要与接受治疗的患者进行比较进一步研究，以确定该治疗方法的使用情况。这也凸显了该病诊断方面持续存在的困难。
