Introduction: Pulmonary embolism (PE) is a potentially life threatening disease, accurate and timely diagnosis of which is still a challenge that physicians face. This study was designed with the aim of evaluating the relationship between thrombosis risk factors, clinical symptoms, and laboratory findings with the presence or absence of PE.
Methods: The present retrospective cross-sectional study was performed on patients with suspected pulmonary embolism who were hospitalized in different departments of Shohadaye Tajrish Hospital, Tehran, Iran, during 1 year. All patients underwent computed tomography pulmonary angiography (CTPA) and then thrombosis risk factors, clinical symptoms, and laboratory findings of confirmed PE cases with CTPA were compared with others.
Results: 188 patients with the mean age of 61.91 ± 18.25 (20 – 101) years were studied (54.8% male). Based on Wells' score, 32 (17.2%) patients were in the low risk group, 145 (78.0%) were in the moderate risk group, and 9 (4.8%) patients were classified in the high risk group for developing PE. CTPA findings confirmed PE diagnosis for 60 (31.7%) patients (6.7% high risk, 75.0% moderate risk, 18.3% low risk). D-dimer test was only ordered for 27 patients, 25 (92.6%) of which were positive. Among the patients with positive D-dimer, 18 (72.0%) cases had negative CTPA. Inactivity (57.4%), hypertension (32.8%), and history of cancer (29.5%) were the most common risk factors of thrombosis in patients with PE. In addition, shortness of breath (60.1%) and tachypnea (11.1%) were the most common clinical findings among patients with PE. There was no significant difference between the patients with PE diagnosis and others regarding mean age (p = 0.560), sex distribution (p = 0.438), and type of thrombosis risk factors (p > 0.05), hospitalization department (p = 0.757), Wells’ score (p = 0.665), electrocardiography findings, or blood gas analyses.
Conclusion: Although attention to thrombosis risk factors, clinical symptoms, and laboratory findings, can be helpful in screening patients with suspected PE, considering the ability of CT scan in confirming or ruling out other possible differential diagnoses, it seems that a revision should be done to lower the threshold of ordering this diagnostic modality for suspected cases.
Richman PB, Courtney DM, Friese J, Matthews J, Field A, Petri R, et al. Prevalence and significance of nonthromboembolic findings on chest computed tomography angiography performed to rule out pulmonary embolism: a multicenter study of 1,025 emergency department patients. Academic emergency medicine. 2004;11(6):642-7.
Anderson FA, Wheeler HB, Goldberg RJ, Hosmer DW, Patwardhan NA, Jovanovic B, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism: the Worcester DVT Study. Archives of internal medicine. 1991;151(5):933-8.
Dismuke SE, Wagner EH. Pulmonary embolism as a cause of death: the changing mortality in hospitalized patients. Jama. 1986;255(15):2039-42.
NORDSTRÖM M, Lindblad B. Autopsy‐verified venous thromboembolism within a defined urban population–the city of Malmö, Sweden. Apmis. 1998;106(1‐6):378-84.
Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data. Archives of internal medicine. 2003;163(14):1711-7.
Kopcke D, Harryman O, Benbow EW, Hay C, Chalmers N. Mortality from pulmonary embolism is decreasing in hospital patients. Journal of the Royal Society of Medicine. 2011;104(8):327-31.
Pollack CV, Schreiber D, Goldhaber SZ, Slattery D, Fanikos J, O'Neil BJ, et al. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: initial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry). Journal of the American College of Cardiology. 2011;57(6):700-6.
Moores LK, Jackson WL, Jr., Shorr AF, Jackson JL. Meta-analysis: outcomes in patients with suspected pulmonary embolism managed with computed tomographic pulmonary angiography. Ann Intern Med. 2004;141(11):866-74.
Raczeck P, Minko P, Graeber S, Fries P, Seidel R, Buecker A, et al. Influence of respiratory position on contrast attenuation in pulmonary CT angiography: a prospective randomized clinical trial. American Journal of Roentgenology. 2016;206(3):481-6.
Adibi A, Nouri S, Moradi M, Shahabi J. Clinical and echocardiographic findings of patients with suspected acute pulmonary thromboembolism who underwent computed tomography pulmonary angiography. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 2016;21.
Sodhi K, Gulati M, Aggarwal R, Kalra N, Mittal B, Jindal S, et al. Computed tomographic pulmonary angiography: utility in acute pulmonary embolism in providing additional information and making alternative clinical diagnosis. Indian journal of medical sciences. 2010;64(1):26.
Members ATF, Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Endorsed by the European Respiratory Society (ERS). European heart journal. 2014;35(43):3033-80.
Chan TC, Vilke GM, Pollack M, Brady WJ. Electrocardiographic manifestations: pulmonary embolism. J Emerg Med. 2001;21(3):263-70.
Sinha N, Yalamanchili K, Sukhija R, Aronow WS, Fleisher AG, Maguire GP, et al. Role of the 12-lead electrocardiogram in diagnosing pulmonary embolism. Cardiology in review. 2005;13(1):46-9.
Bircan A, Karadeniz N, Ozden A, Cakir M, Varol E, Oyar O, et al. A simple clinical model composed of ECG, shock index, and arterial blood gas analysis for predicting severe pulmonary embolism. Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. 2011;17(2):188-96.
Ferrari E, Imbert A, Chevalier T, Mihoubi A, Morand P, Baudouy M. The ECG in pulmonary embolism. Predictive value of negative T waves in precordial leads--80 case reports. Chest. 1997;111(3):537-43.
Rodger MA, Carrier M, Jones GN, Rasuli P, Raymond F, Djunaedi H, et al. Diagnostic value of arterial blood gas measurement in suspected pulmonary embolism. American journal of respiratory and critical care medicine. 2000;162(6):2105-8.
Matsuoka S, Kurihara Y, Yagihashi K, Niimi H, Nakajima Y. Quantification of thin-section CT lung attenuation in acute pulmonary embolism: correlations with arterial blood gas levels and CT angiography. AJR American journal of roentgenology. 2006;186(5):1272-9.
Metafratzi ZM, Vassiliou MP, Maglaras GC, Katzioti FG, Constantopoulos SH, Katsaraki A, et al. Acute pulmonary embolism: correlation of CT pulmonary artery obstruction index with blood gas values. AJR American journal of roentgenology. 2006;186(1):213-9.
Hsu JT, Chu CM, Chang ST, Cheng HW, Cheng NJ, Ho WC, et al. Prognostic role of alveolar-arterial oxygen pressure difference in acute pulmonary embolism. Circulation journal : official journal of the Japanese Circulation Society. 2006;70(12):1611-6.
Masotti L, Ceccarelli E, Cappelli R, Barabesi L, Forconi S. Arterial blood gas analysis and alveolar-arterial oxygen gradient in diagnosis and prognosis of elderly patients with suspected pulmonary embolism. The journals of gerontology Series A, Biological sciences and medical sciences. 2000;55(12):M761-4.
Salanci BV, Kiratli PO, Demir A, Selcuk T. Risk factors of pulmonary thromboembolism in patients from a university hospital. Saudi Med J. 2007;28(4):574-8.