Determination of Demographic Changes of Acute Pulmonary Embolism Patients Applied to Emergency Service: Retrospective Analysis of 60 Cases

Öz

Aim: The aim of this study was to determine the clinical and demographical traits of the increasing number of patients diagnosed with pulmonary embolism and hence to contribute to the literature in order to analyze the possible changes occurred in time. Our study is a retrospective study conducted with all patients over the age of 18 who applied to the emergency service and diagnosed with pulmonary embolism between 01.01.2017 and 01.01.2019. Demographic and clinical data of patients such as patients’ complaints, background story, physical examination and laboratory inspections were determined by analyzing physical files formed at the application and saved data in the information system, and relationship between all the data was analyzed by determination of calculated wells criteria scores. Results: A total of 60 patients were included in the study. The average age of the patients was 64.46 (16.95). Among the patients, 34 (56.7%) were female while 26 (43.3%) were male. Shortness of breath and chest-back pain were the leading complaints of emergency service applications by 36 (60%) and 16 (26%), respectively. The leading background stories of the cases were malignity with 14 (23%) patients, and hypertension with 12 (20%) patients. The most common physical examination indication was bruit with 21 (35%) patients and pretibial edema with 11 (18%) patients, while 12 (20%) patients did not show any symptom. Thrombolytic treatment was applied to 4 patients in the emergency service. Conclusion We believe that studies investigating demographic traits of life-critical and easy to skip diseases like pulmonary embolism which causes to apply to the emergency service will contribute to diagnosis.

Anahtar Kelimeler

• Emergency service
• acute pulmonary embolism
• demographic changes
• Emergency medicine

Öz

Amaç: Bu çalışmayı yapmaktaki amacımız artan pulmoner emboli tanılı hastaların demografik ve klinik özelliklerini belirleyerek zaman içinde olası değişimlerin irdelenebilmesi için literatüre katkı sağlamaktır Methods: Çalışmamız retrospektif bir çalışmadır. Çalışmaya 01.01.2017 ile 01.01.2019 tarihleri arasında acil servise başvuran, 18 yaşından büyük ve akut pulmoner emboli tanısı alan tüm hastalar dâhil edildi. Hastaların başvuru sırasında oluşturulan fiziki dosyaları ve bilgi işlem sistemindeki kayıtlı verileri incelenerek; şikâyetleri, özgeçmiş bilgileri, fizik muayene ve laboratuvar bulguları gibi demografik ve klinik bulguları belirlendi, ayrıca hastaların hesaplanan wells kriterleri puanları belirlenerek tüm bu verilerin birbiriyle ilintisi araştırıldı. Bulgular: Çalışmaya toplam 60 hasta dâhil edildi. Çalışmaya dâhil edilen hastaların yaş ortalaması 64,46(16,95) idi. Cinsiyet açısından irdelendiğinde ise hastaların 34 (56,7)’ü kadın, 26 (%43,3)’sı ise erkekti. Olguların acil servise başvuru şikâyetleri içerisinde nefes darlığı 36 (%60) ve göğüs-sırt ağrısı 16 (%26) ilk sıralardaydı. Olguların özgeçmiş özellikleri içerisinde ise ilk sırada 14 (%23) hasta ile malignite ve 12 (%20) hasta ile hipertansiyon yer almaktaydı. En sık rastalanan fizik muayene bulgusu ral 21(%35) ve pretibial ödem 11(%18) iken 12 (%20) hastada herhangi bir bulguya rastlanmadı. 4 hastaya tedavi için acil serviste trombolitik tedavi uygulandı. Sonuç Pulmoner emboli gibi acil servise başvuran hem hayati tehlikesi yüksek hem de kolay atlanabilen hastalıkların demografik özelliklerinin araştırıldığı çalışmaların tanıya katkı sağlayacağına inanmaktayız

Anahtar Kelimeler

• Acil servis
• akut pulmoner emboli
• demografik değişim

Kaynakça

1. Wendelboe AM, Raskob GE. Global Burden of Thrombosis: Epidemiologic Aspects. Circ Res. 2016;118(9):1340–7.
2. Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous Thromboembolism. A Public Health Concern. Am J Prev Med [Internet]. 2010;38(4 SUPPL.): S495–501. Available from: http://dx.doi.org/10.1016/j.amepre.2009.12.017
3. Khan F, Tritschler T, Kahn SR, Rodger MA. Venous thromboembolism. Lancet [Internet]. 2021;398(10294):64–77. Available from: http://dx.doi.org/10.1016/S0140-6736(20)32658-1
4. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Veli-Pekka Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)The Task Force for the diagnosis and management of acute pulmonary embolism of the.
5. Baloescu C. Diagnostic Imaging in Emergency Medicine: How Much Is Too Much? Ann Emerg Med. 2018;72:637-643.https://doi.org/10.1016/j.annemergmed.2018.06.034
6. Duru S, Ergun R, Dilli A, Kaplan T, Kaplan B, Ardic S. Clinical, laboratory and computed tomography pulmonary angiography results in pulmonary embolism: retrospective evaluation of 205 patients. Anatol J Cardiol. 2012;12(2):142–50.
7. Lilienfeld DE. Decreasing mortality from pulmonary embolism in the United States, 1979-1996. Int J Epidemiol. 2000;29(3):465–9.
8. Mutlu LC. Altmış üç Pulmoner Emboli Olgusunun Retrospektif Değerlendirilmesi. Solunum Hastalıkları 2004; 15: 15-21

9. The PIOPED investigators. Value of the ventilation/perfusion in acute pulmonary embolism: Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 1990;263:2753-9.
10. Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 2000;83:416-420.
11. Klok FA, Mos IC, Nijkeuter M, Righini M, Perrier A, Le Gal G, Huisman MV. Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism. Arch Intern Med 2008;168:2131-2136.
12. Gibson NS, Sohne M, Kruip MJHA, Tick LW, Gerdes VE, Bossuyt PM, Wells PS, Buller HR; Christopher Study Investigators. Further validation and simplification of the Wells clinical decision rule in pulmonary embolism. Thromb Haemost 2008;99:229-234.