Clinical characteristics of fatal pulmonary embolism in a referral hospital.

OBJECTIVE

To determine the clinical characteristics of hospitalized patients who died of pulmonary embolism, confirmed by evaluative autopsy.

DESIGN

We retrospectively analyzed a series of autopsy cases of pulmonary embolism at a tertiary-care center for the period Jan. 1, 1985, through Dec. 31, 1989.

MATERIAL AND METHODS

The medical and autopsy records of all hospitalized patients with autopsy-proven fatal pulmonary embolism were reviewed. Cases of tumor emboli, fat emboli, and contributory-only thromboembolic disease were excluded from the study. Specific symptoms and signs, diagnostic studies, and prophylactic measures were noted.

RESULTS

Among 2,427 autopsies performed during the 5-year study period, death in 92 (3.8%) was clinically and pathologically judged to be caused by pulmonary embolism. No risk factors were noted in only 11 patients (12%). Prophylaxis against thromboembolism was used in 46%. Classic symptoms were often absent: dyspnea was present in only 59%, chest pain in only 17%, and hemoptysis in 3%. Pulmonary embolism was considered in 49% of the 92 patients and was correctly assigned as the cause of death on the death certificate or in the medical records in 32%. Testing for venous thromboembolic disease was performed in 22%. Comorbidity was present in most patients: 54% had guarded or poor prognoses independent of pulmonary embolism.

CONCLUSION

The usual signs and symptoms associated with pulmonary embolism did not adequately identify most of our patients who died of pulmonary embolism. The reasons included the absence of these signs and symptoms, inability to communicate (for example, sedated or comatose patient), sudden death from acute massive pulmonary embolism, and presence of comorbid factors.