Demographic characteristics of patients with pulmonary thromboembolism

Abstract

Objective: Pulmonary thromboembolism (PTE) is a common disease with high mortality and difficult diagnosis. The incidence in our country cannot be calculated because there is no adequate and regular data. In our study, we aimed to investigate the demographic characteristics, risk factors, incidence, Wells and Geneva scores diagnostic and treatment methods of the patients in our emergency department with a diagnosis of PTE. Methods: Files of the 112 patients who were admitted to Erciyes University Medical Faculty Emergency Department between January 2010 - February 2012 were analyzed retrospectively. Data were analyzed with SPSS 17.0 statistical software. Results: The mean age of patients was 65.02 ± 16.23. Forty-one (36.6%) of the patients were male and 71 (63.4%) were female. The most common complaint of patients was shortness of breath (81.3%), respectively. Immobilization(35.7%) and history of previous surgery (19.6%) were among the risk factors of the patients. Average troponin levels of the patients was 0.13 ± 0.48 ng/L and average d-dimer levels was 12.698.12 ± 8.779.92 µg/L. Geneva scores of the patients were: 4 patients (3.6%) low score, 88 patients (78.6%) medium score and 20 patients (17.9%) high score. Wells Clinical Probability scores of the patients were; 1 patient (0.9%) low probability, 74 patients (66.1%) intermediate probability and 37 patients (33%) high probability. In the treatment of patients; heparin infusion (36.6%), enoxaparin sodium (59.8%) and tPA (3.6%) were used. Conclusion: In spite of improvements in diagnosis and treatment methods, pulmonary embolism diagnosis is stil a problem. The first step to diagnosis in patients with risk factors begin to suspect. J Clin Exp Invest 2015; 6 (1): 10-15 Key words: pulmonary embolism, diagnosis, treatment, demographic characteristics

Keywords

• pulmonary embolism, diagnosis, treatment, demographic characteristics

Pulmoner tromboemboli hastalarının demografik özellikleri

Öz

Amaç: Pulmoner tromboemboli (PTE) sık görülen, tanısında zorlanılan ve mortalitesi yüksek olan bir hastalıktır. Ülkemizdeki sıklığı ise yeterli ve düzenli veri bulunmadığı için hesaplanamamaktadır. Bu çalışmada acil servisimizde PTE tanısı alan hastaların demografik özellikleri, risk faktörleri, insidansı, Wells ve Geneva skorları, tanı ve tedavi yöntemlerini araştırmayı planladık.Yöntemler: Ocak 2010 – Şubat 2012 tarihleri arasında Erciyes Üniversitesi Tıp Fakültesi Acil Servisinde PTE tanısı konulan 112 hastanın dosyaları geriye dönük olarak incelendi. Veriler SPSS 17.0 programı ile değerlendirildi.Bulgular: Hastaların yaş ortalaması 65,02 ± 16,23 yıl idi. Hastaların 41’i (%36,6) erkek, 71’i (%63,4) kadın idi. Hastaların acil servise başvuru şikayetlerinde en sık nefes darlığı (%81,3) idi. Hastaların risk faktörlerinde immobilizasyon (%35,7), geçirilmiş cerrahi hikayesi (%19,6) mevcut idi. Hastaların troponin ortalaması 0,13 ± 0,48 ng/L ve d-dimer ortalaması 8779,92 ± 12698,12 µg/L idi. Hastaların Geneva Skorlamasında; 4 hastanın (%3,6) skoru düşük, 88 hastanın (%78,6) skoru orta ve 20 hastanın (%17,9) skoru yüksek iken Wells Klinik Olasılık Skorlamasında; 1 hastanın (%0,9) skoru düşük olasılıklı, 74 hastanın (%66,1) skoru orta olasılıklı ve 37 hastanın (%33) skoru yüksek olasılıklı idi. Hastaların tedavilerinde; heparin infüzyonu (% 36,6), enoxaparin (%59,8) ve tPA (%3,6) kullanıldı.Sonuç: Pulmoner tromboemboli tanı ve tedavi araçların gelişmesine rağmen tanı koymakta zorlanan bir hastalık olmaya devam etmektedir. Tanı için ilk adım risk faktörleri olan hastalarda şüphelenmekle başlamaktadır

Anahtar Kelimeler

• Pulmoner tromboemboli, tanı, tedavi, demografik özellikler

References

1. Yılmaz S, Topçu F, Şen H.S, et al. Combination of
2. Wells clinical score and high D-dimer levels in the in
3. diagnosis of pulmonary embolism. J Clin Exp Invest
4. ;5:557-562.
5. Şen HS, Abakay Ö, Taylan M, et al. The importance of
6. mean platelet volume in early mortality of pulmonary
7. embolism. J Clin Exp Invest 2013;4:298-301.
8. Torbicki A, van Beek E.J.R, Charbonnier B, et al. Task

9. Force Report. Guidelines on Diagnosis and Management
10. of Acute Pulmonary Embolism. Eur Heart J.
11. ;21:1301-1336.
12. Şen HS, Abakay Ö, et al. Current diagnosis and treatment
13. in pulmonary thromboembolism. J Clin Exp Invest
14. ;4:405-410.
15. Erkan L. Pulmoner Tromboembolizm Özel Sayısı. Ed.
16. Numan Numanoglu. Türkiye Klinikleri Gögüs Hastalıkları
17. ;1.
18. Nijkeuter M, Söhne M, Tick LW, et al. The natural
19. course of hemodynamically stable pulmonary embolism.
20. Chest 2007;131:517-523.
21. Yung GL, Fedullo PF. Disorders of the pulmonary circulation
22. Part IX; Pulmonary Thromboembolic Disease
23. in: Fishman A.P, Elias J.A, Fishman J.A, et al. Fishman’s
24. Pulmonary Diseases and Disorders. 4th ed.
25. Philadelphia 2008;2:14.
26. Stein PD, Hull RD, Saltzman HA, et al. Strategy for
27. diagnosis of patients with suspected acute pulmonary
28. embolism. Chest 1993;103:1553-1559.
29. Van B.A, Buller H.R, Huisman M.V, et al. Effectiveness
30. of managing suspected pulmonary embolism using an
31. algorithm combining clinical probability, D-dimer testing,
32. and computed tomography. JAMA 2006;295:172.
33. Tsai AW, Cushman M, Rosamond W.D, et al. Cardiovascular
34. risk factors and venous thromboembolism incidence:
35. the longitudinal investigation of thromboembolism
36. etiology. Arch Intern Med 2002;162:1182-1189.
37. Sangyeub L, Hyecheol J, et al. Clinical characteristics
38. of acute pulmonary thromboembolism in Korea. International
39. Journal of Cardiology 2006;108:84–88.
40. Mashio N, Masahito S, Norikazu Y, et al. Risk factors
41. of acute pulmonary thromboembolism in Japanese
42. patients hospitalized for medical illness: results of a
43. multicenter registry in the Japanese society of pulmonary
44. embolism research. J Thromb Thrombolysis
45. ;21:131-135.
46. Miniati M, Prediletto R, et al. Accuracy of clinical assessment
47. in the diagnosis of pulmonary embolism.
48. Am J Respir Crit Care Med 1999;159:864–871.
49. White RH. The epidemiology of venous thromboembolism.
50. Circulation 2003; 107: I4-I8.
51. Geibel A, Zehender M, et al. Prognostic value of the
52. ECG on admission in patients with acute major pulmonary
53. embolism. Eur Respir J 2005;25:843–848.
54. Güzel A, Yavuz Y, Şişman B, et al. Acil servise baş-
55. vuran pulmoner tromboemboli olgularinin retrospektif
56. olarak değerlendirilmesi. J Academ Emerg Med
57. 034.
58. Kelly J, Rudd A, Lewis RR, et al. Plasma D-dimers in
59. the diagnosis of venous thromboembolism. Arch Intern
60. Med 2002;162:747-756.
61. Pollack CV, Schreiber D, Goldhaber SZ, et al. Clinical
62. characteristics, management, and outcomes of
63. patients diagnosed with acute pulmonary embolism in
64. the emergency department. JACC 2011;57:700-706.
65. Pruszczyk P, Bochowicz A, Torbicki A, et al. Cardiac
66. troponin T monitoring identifies high-risk group of normotensive
67. patients with acute pulmonary embolism.
68. Chest 2003;123:1947-1952.
69. Frémont B, Pacouret G, Jacobi D, et al. Prognostic
70. value of echocardiographic right/left ventricular enddiastolic
71. diameter ratio in patients with acute pulmonary
72. embolism: results from a monocenter registry of
73. patients. Chest 2008;133:358-362.
74. The PIOPED Investigators. Value of the ventilation/
75. perfusion scan in acute pulmonary embolism. Results
76. of the prospective investigation of pulmonary embolism
77. diagnosis (PIOPED). JAMA 1990;263:2753-
78. -
79. Tapson VF. Acute pulmonary embolism. N Engl J Med
80. ;358:1037-1052.
81. Buller HR, Agnelli G, Hull RD, et al. Antithrombotic
82. therapy for venous thromboembolic disease: the Seventh
83. ACCP Conference on Antithrombotic and Thrombolytic
84. Therapy. Chest 2004;126:163-696.