D-Y Gong1, X-F Liu, F-J Huang. 1. Department of Forensic Pathology, Sichuan University, Chengdu, People's Republic of China.
Abstract
AIM: Due to non-specific symptoms and imaging features, a timely and accurate diagnosis of pulmonary thromboembolism (PTE) is often difficult. This study aims to evaluate the frequency of, and risk factors for, autopsy-confirmed cases with fatal pulmonary thromboembolism (FPE) that were missed or misdiagnosed before death. MATERIAL AND METHODS: Forensic autopsies that were performed at the Center of Forensic Medicine in West China were retrospectively reviewed, and demographic and clinical data of autopsy-confirmed cases with FPE were collected. RESULTS: There were 41 cases with pathologically confirmed FPE, which represents 7.3% (41/558) of autopsy cases that documented sudden death in hospital. Of those 41 cases, only 14.6% (6/41) were correctly diagnosed before death, and 85.4% (35/41) were missed or misdiagnosed. According to medical records, bowel movements and out-of-bed activity were the major triggers of FPE death, and 90% of cases had at least two of the known risk factors for PTE. Increasing age, orthopedic surgery, and multiple traumas were the most common risk factors. Additionally, of the 41 cases with FPE, 51.2% (21/41) died in the Orthopedic Department. CONCLUSIONS: FPE was common in older patients who had a recent history of surgery and multiple traumas. Increasing the early diagnosis of PTE in high-risk patients may be useful for reducing the incidence of FPE.
AIM: Due to non-specific symptoms and imaging features, a timely and accurate diagnosis of pulmonary thromboembolism (PTE) is often difficult. This study aims to evaluate the frequency of, and risk factors for, autopsy-confirmed cases with fatal pulmonary thromboembolism (FPE) that were missed or misdiagnosed before death. MATERIAL AND METHODS: Forensic autopsies that were performed at the Center of Forensic Medicine in West China were retrospectively reviewed, and demographic and clinical data of autopsy-confirmed cases with FPE were collected. RESULTS: There were 41 cases with pathologically confirmed FPE, which represents 7.3% (41/558) of autopsy cases that documented sudden death in hospital. Of those 41 cases, only 14.6% (6/41) were correctly diagnosed before death, and 85.4% (35/41) were missed or misdiagnosed. According to medical records, bowel movements and out-of-bed activity were the major triggers of FPE death, and 90% of cases had at least two of the known risk factors for PTE. Increasing age, orthopedic surgery, and multiple traumas were the most common risk factors. Additionally, of the 41 cases with FPE, 51.2% (21/41) died in the Orthopedic Department. CONCLUSIONS: FPE was common in older patients who had a recent history of surgery and multiple traumas. Increasing the early diagnosis of PTE in high-risk patients may be useful for reducing the incidence of FPE.
Authors: Aline Domingos Pinto Ruppert; Alexandre de Matos Soeiro; Maria Carolina Feres de Almeida; Múcio Tavares de Oliveira; Carlos V Serrano; Vera Luiza Capelozzi Journal: Open Access Emerg Med Date: 2014-03-10