Göğüs Hastalıkları Hastanesi Acil Servisi'nde Şüpheli Pulmoner Embolizm Tanısı ile Başvuran Hastalarda Tanı Doğruluğu

Yıl 2025, Cilt: 39 Sayı: 1, 23 - 36, 31.05.2025

Eylem Yıldırım , Dursun Tatar

Öz

Öz (tr)
Amaç: Bu çalışmanın amacı, pulmoner tromboembolizm (PTE) ön tanısı ile akciğer hastalıkları hastanesi acil servisine başvuran hastaların tanı doğruluğunu değerlendirmektir.

Materyal ve Metot: Retrospektif olarak gerçekleştirilen bu çalışmada, bir yıllık süre zarfında İzmir Dr. Suat Seren Göğüs Hastalıkları ve Cerrahi Eğitim ve Araştırma Hastanesi Acil Servisi'ne PTE şüphesiyle başvuran 124 hasta incelenmiştir. Demografik veriler, klinik semptomlar (dispne, göğüs ağrısı, senkop), risk faktörleri (immobilizasyon, malignite) ve laboratuvar bulguları (D-dimer, pro-BNP) kaydedilmiştir. Tanısal yaklaşımlarda bilgisayarlı tomografi pulmoner anjiyografi (CTPA) ve ventilasyon-perfüzyon (V/Q) sintigrafisi gibi yöntemlere başvurulmuştur. Risk sınıflandırması için Wells skoru ve basitleştirilmiş Pulmoner Embolizm Şiddet Endeksi (sPESI) kullanılmıştır.

Bulgular: Hastaların ortalama yaşı 65.6 ± 16.9 yıl olup, %58.9'u kadındı. En yaygın semptom dispne (%88.7) iken, bunu sırasıyla göğüs ağrısı (%30.6) ve senkop (%6.5) takip etmiştir. Sağ ventrikül aşırı yüklemesi, hastaların %36.1'inde gözlemlenmiştir. PTE, 69 hastada (%55.6) doğrulanırken, 55 hastada (%44.4) ekarte edilmiştir. D-dimer seviyeleri, PTE hastalarında anlamlı şekilde daha yüksek bulunmuştur (4445.8 ± 3279.2 vs. 2561.9 ± 2450.7, p=0.003). PTE grubundaki hastaların Wells skorları daha yüksek çıkmış; yüksek olasılık grubunda PTE hastalarında %30.4 iken, non-PTE grubunda bu oran %5.5 olarak belirlenmiştir (p<0.001). Ayrıca, immobilizasyon oranları PTE grubunda %55.1 iken, non-PTE grubunda %32.7 olarak saptanmıştır (p=0.020). Tanısal yöntem olarak CTPA, PTE hastalarında %78.3, non-PTE hastalarında ise %60 oranında kullanılmıştır (p=0.170).

Sonuç: Bu çalışma, PTE tanısında klinik skor sistemleri, laboratuvar belirteçleri ve görüntüleme yöntemlerinin entegrasyonunun önemini ortaya koymakta; yapılandırılmış bir yaklaşımın tanı doğruluğunu artırarak hasta yönetimini iyileştirdiğini göstermektedir.

Öz (en)
Objective: This study aims to assess the diagnostic accuracy of patients referred to a pulmonary disease hospital emergency department with a preliminary diagnosis of pulmonary thromboembolism (PTE).
Material and Methods: In this retrospective study, 124 patients referred to the Emergency Department of Izmir Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital over one year with a suspected PTE diagnosis were included. Data on demographics, clinical symptoms (dyspnea, chest pain, syncope), risk factors (immobilization, malignancy), and laboratory findings (D-dimer, pro-BNP) were collected. Diagnostic tools such as computed tomography pulmonary angiography (CTPA) and ventilation-perfusion (V/Q) scintigraphy were recorded. The Wells score and simplified Pulmonary Embolism Severity Index (sPESI) were used for risk stratification.
Results: The mean patient age was 65.6 ± 16.9 years, with 58.9% female. Dyspnea was the most common symptom (88.7%), followed by chest pain (30.6%) and syncope (6.5%). Right ventricular overload was observed in 36.1% of patients. PTE was confirmed in 69 patients (55.6%) and excluded in 55 patients (44.4%). D-dimer levels were significantly higher in PTE patients (4445.8 ± 3279.2 vs. 2561.9 ± 2450.7, p=0.003). Patients with PTE had higher Wells scores (30.4% high probability vs. 5.5%, p<0.001) and higher rates of immobilization (55.1% vs. 32.7%, p=0.020). CTPA was the most used diagnostic method (78.3% in PTE vs. 60% in non-PTE, p=0.170).
Conclusion: This study highlights the value of integrating clinical scoring systems, laboratory markers, and imaging methods in diagnosing PTE, demonstrating that a structured approach improves diagnostic accuracy and patient management.

Anahtar Kelimeler

Bilgisayarlı tomografi, D-dimer, Pulmoner embolizm, risk sınıflandırması, şüpheli pulmoner embolizm

Etik Beyan

etik beyan var

Kaynakça

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