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Fatal pulmonary emboli in hospitalized patients. An autopsy study
I Rubinstein1, D Murray, V Hoffstein
1Department of Medicine, St Michael's Hospital, University of Toronto, Ontario, Canada.
Abstract:
To determine the accuracy of the antemortem diagnosis of major pulmonary embolism, we reviewed 1276 autopsy reports at St Michael's Hospital, Toronto, from 1980 to 1984. Of 44 patients identified with major pulmonary embolism as the cause of death or a major factor contributing to it, 14 (31.8%) had the diagnosis suspected before death. We could not find any distinctive features separating these patients from those in whom the diagnosis of pulmonary embolism was not suspected before death. We conclude that major pulmonary embolism is still underdiagnosed in hospitalized patients, despite the availability of lung scanning and pulmonary angiography.
Insights
Major pulmonary embolism remains underdiagnosed in hospitalized patients. Despite advanced diagnostic tools, less than half of fatal cases were suspected antemortem, highlighting a critical gap in clinical recognition.
Area of Science:
- Cardiology
- Pulmonology
- Medical Diagnostics
Background:
- Pulmonary embolism (PE) is a significant cause of mortality.
- Accurate antemortem diagnosis of PE is crucial for timely treatment.
- Despite available diagnostic technologies, PE diagnosis can be challenging.
Purpose of the Study:
- To evaluate the accuracy of antemortem diagnosis for major pulmonary embolism.
- To assess the rate of suspected PE in patients who died from or with PE.
Main Methods:
- Retrospective review of 1276 autopsy reports from St Michael's Hospital, Toronto (1980-1984).
- Identification of patients with major pulmonary embolism as a cause of death or contributing factor.
- Comparison of clinical features between patients with and without suspected PE antemortem.
Main Results:
- 44 patients had major pulmonary embolism identified during autopsy.
- Only 14 (31.8%) of these patients had PE suspected before death.
- No distinctive clinical features differentiated suspected from unsuspected PE cases.
Conclusions:
- Major pulmonary embolism is frequently underdiagnosed in hospitalized patients.
- The availability of lung scanning and pulmonary angiography has not significantly improved antemortem diagnosis rates.
- There is a need for improved clinical awareness and diagnostic strategies for PE.