Investigation on diagnosis and treatment of pulmonary embolism in a three grade hospital in recent 10 years and the difference among departments

Abstract

Objective To analyze the diagnosis and treatment of pulmonary embolism (PE) in our hospital in recent 10 years, and to understand the difference among different departments in the process. Methods Through analyzing the clinical data of discharge diagnosis with PE in patients betweenJanuary 1, 2006 and October 1, 2015, these clinical indexes of discharge patients with PE, such as the cases number, the first consultation department, diagnostic methods, and these clinical indexes of confirmed patients with PE, such as risk factors, clinical manifestation, electrocardiogram, echocardiography, myocardial enzymes, troponin, brain natriuretic peptide, lower extremity vascular ultrasound, D-dimer examination, arterial blood gas analysis, vascular ultrasound examination of lower extremity, anticoagulant, the start time of anticoagulation, misdiagnosis and the prognosis were investigated. Results ①the number of PE cases increased year by year, and a total of 375 cases of patients were diagnosed with PE including 231 confirmed cases and 144 cases with clinical diagnosis. Two hundred and twenty-one confirmed cases(95.67%)were diagnosed by computed tomography pulmonary angiography that was the main method for the diagnosis of PE in our investigation. Among which the top four diagnosis departments of PE were respiratory department, cardiovascular department, general surgery and emergency department (36.80%, 23.81%, 17.75% and 8.23%, respectively). There were 8 cases of death (3.46%), 24 cases of automatic discharge/transfer (10.39%) and 24 cases of misdiagnosis (10.39%) in the confirmed patients with PE. ②the clinical manifestation of confirmed patients with PE in the top three were dyspnea (77.49%), cough (35.93%) and lower limb swelling (35.93%), respectively. ③the risk factors of confirmed patients with PE in the top four were in bed (20.35%), cancer (16.02%), medical history of deep venous thrombosis (9.96%) and post-operation of orthopedics (9.52%), respectively. ④of these confirmed patients with PE, 24 cases (10.39%) were only given symptomatic treatment, 80.52% were treated with low molecular weight heparin (LMWH) and 70.56% were given therapy of warfarin, but only 32.03% were treated with LMWH at the first day of diagnosis and the international normalized ratio (INR) of 33.33% discharge patients reached 2 to 3. ⑤when compared to other departments, there were significant differences in D-dimer examination(χ2=4.025, P=0.045), arterial blood gas analysis(χ2=5.953, P=0.015), electrocardiography(χ2=5.682, P=0.017), and the implementation of patients with INR of 2-3 at discharge in respiratory department(χ2=26.143, P<0.001). No significant differences were found in echocardiography(χ2=2.153, P=0.142), brain natriuretic peptide detection (χ2=0.019, P=0.891), myocardial enzyme examination (χ2=1.357, P=0.244), troponin assays(χ2=1.772, P=0.183), vascular ultrasound examination of lower extremity(χ2=0.722, P= 0.395), symptomatic treatment(χ2=0.670, P=0.413), anticoagulation with warfarin at the first day after the diagnosis(χ2=1.417, P=0.234), anticoagulation with LMWH at the first day after the diagnosis(χ2=3.362, P=0.067), overlapping anticoagulation with heparin and warfarin at the same day after the diagnosis(χ2=3.482, P=0.062), between respiratory department and the other departments. Conclusion In patients with PE, high risk factors are shown and the clinical features are not typical. The awareness of the diagnosis with PE in our hospital has been increasing, but the consciousness of the auxiliary examination and the risk stratification were still poor and the level of treatment need to be further improved. Key words: Pulmonary embolism; Examination; Diagnosis/treatment; Guidelines