[Reliability of clinical parameters in the diagnosis of pulmonary thromboembolism at an emergency department].

BACKGROUND

Pulmonary thromboembolism (PTE) mortality rate is four times greater among non-diagnosed than among diagnosed and hence suitably treated patients. Diagnosis, however, may be difficult due to the aspecific and polymorphic clinical picture of the disease.

OBJECTIVE

We made a comparison between two groups of patients with PTE. In the first group the diagnosis was immediately suspected, in the second group it was delayed. The aim of our work was to identify any clinical or laboratory feature which may be helpful (singularly or jointly considered) to immediately recognize PTE in the Emergency Department.

MATERIALS AND METHODS

62 patients with PTE were studied retrospectively in 5 consecutive years. They came to E.D. because of symptoms and signs of cardiorespiratory failure. Pulmonary embolism was demonstrated in 60 cases by high probability pulmonary scan; in 2 cases (who suddenly died after the first visit) by autopsy. They were divided in two groups according to the first provisional diagnosis made after the first visit: group A (n 33 = 53.2%) with assumed pulmonary embolism; group B (n 29 = 46.8%) with other diagnosis. History, clinical findings, ECG, chest X-ray, blood gas analysis and routine laboratory tests were then compared between group A and group B patients.

RESULTS

No differences were observed between diagnosed and non-diagnosed patients, except for a significantly higher rate of clinically overt deep venous thrombosis in group A. Three main clinical pictures were detected among our patients: 1-circulatory collapse syndrome: n = 20 (32.3%), of whom 8 in group A and 12 in group B (p = n.s.); 2-pulmonary infarction syndrome: n = 12 (19.4%), of whom 5 in group A and 7 in group B (p = n.s.); 3-uncomplicated embolism syndrome: n = 30 (48.4%), of whom 20 in group A and 10 in group B (p = n.s.).

CONCLUSIONS

In our study, history and signs of deep vein thrombosis were the only clues significantly more represented in early diagnosed cases. The possibility of thromboembolic accident should never be dismissed, even despite lack of a proven emboligenous cause in patients with unexplained chest pain or cardiorespiratory failure.