Prevalence of Pulmonary Thromboembolism in Patients Admitted to Emergency Department

Abstract

Pulmonary thromboembolism (PTE) is caused by thrombus originating from deep leg veins and obstructing the pulmonary artery and/or its branches. PTE is a preventable disease with high mortality and morbidity. It may relapse and is sometimes difficult to diagnose. The average annual incidence of venous thromboembolism (VTE) is 23-269/100.000 and it increases with age. The risk of VTE is 10 times higher after 80 years of age than at the age of 45-50 years (1-4).Emergency physicians and chest disease specialists often demand some tests more than necessary to exclude the diagnosis of PTE. Although D-dimer test is widely used, false positive rate is high. In addition, when the pulmonary computed tomography (CT) angiography is used more than necessary in the emergency department, it has high cost and many other risks such as radiation and contrast-induced acute kidney failure (5).Although pulmonary CT angiography is a very effective method in the diagnosis of thromboembolic lesions located in the main and lobar pulmonary artery branches, its sensitivity in Objective: Pulmonary thromboembolism (PTE) is caused by thrombus originating from deep leg veins and obstructing the pulmonary artery and/ or its branches. PTE is a preventable disease with high mortality and morbidity. It may relapse and is sometimes difficult to diagnose. Unnecessary diagnostic tests are applied to many patients with suspected PTE. The aim of this study was to investigate the frequency of PTE in patients presenting with a preliminary diagnosis of PTE to emergency clinic of a tertiary chest diseases hospital. Methods:The triage forms of all patients who were admitted to the emergency clinic of tertiary chest diseases hospital within one year were examined. Demographic characteristics, risk factors for PTE, examinations and definite diagnosis data were obtained from the automation system of our hospital and evaluated retrospectively. Results:In 2012, the number of patients admitted to the emergency department was 33,413 and 411 patients (0.12%) were examined with preliminary diagnosis of PTE. After initial evaluation, 292 patients (71%) were hospitalized, 117 patients (28.5%) were called for outpatient clinic follow-up, and two patients were referred to another hospital with non-PTE diagnosis (0.5%). After examinations at outpatient clinic or hospital admission, PTE was detected in 111 patients (27%) and deep vein thrombosis was found in 19 patients (4.6%). While 236 patients (57.4%) were diagnosed as non-PTE, 6 patients (1.5%) died before a definite diagnosis and 39 patients (9.5%) did not attend outpatient clinic examinations. PTE was detected in 16.2% (n=19) of the patients followed in outpatient clinic and in 31.5% (n=92) of the hospitalized patients. Conclusion:In conclusion, the frequency of suspected PTE was 0.12% in patients admitted to the emergency department and 27% of these patients were diagnosed with definite PTE.