[Pulmonary artery thromboembolism: factors of prehospital overdiagnosis]

Detection and analysis of factors of pulmonary artery thromboembolism (PATE) overdiagnosis in a prehospital setting.

A total of 102 patients with prehospital diagnosis of PATE entered the study. Prehospital clinical and ECG picture was compared in groups of verified PATE (n=61) and rejected PATE (n=41). Clinical probability of PATE was assessed retrospectively according to Revised Geneva Score (RGS) scale. In 47 cases the analysis was made in dynamics (in 92 +/- 42.1 min, on the average).

In the group of patients with false-positive PATE diagnosis we significantly more frequently observed angina-like chest pain and satisfactory condition at examination, ECG evidence for right heart overloading (the most significant marker S(I)-Q(III); p=0.009) occurred less often, mean heart rate was significantly lower than in patients with verified PATE (85 +/- 23,8 and 100 +/- 23,0 b/min, respectively; p = 0,007). Low probability of PATE by the RGS scale was stated in 37% patients from the group with false-positive diagnosis and only in 8% patients with a verified diagnosis of PATE (p = 0.0005).

Prehospital PATE overdiagnosis can be explained by non-specificity of clinical and ECG picture of the disease in acute period. Application of the RGS scale is effective for objective assessment of the condition and accurate diagnosis.