Stein P D, Henry J W
Henry Ford Heart and Vascular Institute, Detroit, MI 48202-2691, USA.
Chest. 1995 Oct;108(4):978-81. doi: 10.1378/chest.108.4.978.
The purpose of this investigation is to estimate the prevalence of acute pulmonary embolism (PE) in a general hospital, its frequency among patients who died, and the ability of physicians to diagnose PE antemortem.
The prevalence of acute PE among 51,645 patients hospitalized over a 21-month period was assessed in 1 of the 6 clinical centers (Henry Ford Hospital) that participated in the collaborative study, prospective investigation of pulmonary embolism diagnosis (PIOPED). The diagnosis of PE was made by pulmonary angiography, or in those who did not undergo pulmonary angiography because they declined or were ineligible for randomization to angiography in PIOPED, the diagnosis was based on the ventilation/perfusion (V/Q) lung scan. Based on data in PIOPED, PE was considered to be present in 87% of patients with high probability V/Q scam interpretations, 30% with intermediate probability interpretations, 14% with low probability interpretations, and 4% with nearly normal V/Q scans.
The estimated prevalence of acute PE in hospitalized patients was 526 of 51,645 (1.0%; 95% confidence interval [CI], 0.9 to 1.1%). Based on extrapolated data from autopsy, PE was estimated to have caused or contributed to death in 122 of 51,645 (0.2%; 95% CI, 0.19 to 0.29%). Pulmonary embolism was observed at autopsy in 59 of 404 (14.6%; 95% CI, 11.3 to 18.4%). Among patients with PE at autopsy, the PE caused or contributed to death in 22 of 59 (37.3%; 95% CI, 25.0 to 50.9%) and PE was incidental in 37 of 59 (62.7%; 95% CI, 49.1 to 75.0%). Among patients at autopsy who died from PE, the diagnosis was unsuspected in 14 of 20 (70.0%; 95% CI, 45.7 to 88.1%). Most of these patients had advanced associated disease. In these patients, death from PE occurred within 2.5 h in 13 of 14 (92.9%; 95% CI, 66.1 to 99.8%).
Pulmonary embolism is common in a general hospital. The prevalence of PE at autopsy has not changed over 3 decades. The frequency of unsuspected PE in patients at autopsy has not diminished. Even among patients who die from PE, the PE is usually unsuspected. Such patients, however, typically have advanced disease. Among moribund patients, incidental PE is rarely diagnosed. Patients who suffer sudden unexplained catastrophic events in the hospital are a group in whom the diagnosis might be suspected more frequently if physicians maintain a high index of suspicion.
本研究旨在评估综合医院中急性肺栓塞（PE）的患病率、其在死亡患者中的发生频率以及医生生前诊断PE的能力。
在参与协作研究“肺栓塞诊断前瞻性调查（PIOPED）”的6个临床中心之一（亨利·福特医院），对21个月期间住院的51645例患者中的急性PE患病率进行了评估。PE的诊断通过肺血管造影进行，对于那些因拒绝或不符合PIOPED中血管造影随机分组条件而未接受肺血管造影的患者，诊断基于通气/灌注（V/Q）肺扫描。根据PIOPED中的数据，V/Q扫描解释为高概率的患者中87%被认为存在PE，中等概率解释的患者中30%存在PE，低概率解释的患者中14%存在PE，V/Q扫描几乎正常的患者中4%存在PE。
住院患者中急性PE的估计患病率为51645例中的526例（1.0%；95%置信区间[CI]，0.9至1.1%）。根据尸检推断数据，估计51645例中有122例（0.2%；95%CI，0.19至0.29%）的死亡由PE导致或与之相关。404例尸检中有59例（14.6%；95%CI，11.3至18.4%）观察到肺栓塞。在尸检发现有PE的患者中，PE导致或促成死亡的有59例中的22例（37.3%；95%CI，25.0至50.9%），PE为偶然发现的有59例中的37例（62.7%；95%CI，49.1至75.0%）。在因PE死亡的尸检患者中，20例中有14例（70.0%；95%CI，45.7至88.1%）生前未被怀疑患有该病。这些患者大多伴有晚期相关疾病。在这些患者中，14例中有13例（92.9%；95%CI，66.1至99.8%）在2.5小时内死于PE。
肺栓塞在综合医院中很常见。尸检中PE的患病率在30年中未发生变化。尸检患者中未被怀疑的PE发生率并未降低。即使在死于PE的患者中，PE通常也未被怀疑。然而，这类患者通常患有晚期疾病。在濒死患者中，偶然发现的PE很少被诊断出来。如果医生保持高度的怀疑指数，医院中突发不明灾难性事件的患者群体可能更常被怀疑患有该病。
