CLINICAL CHARACTERISTICS OF FATAL PULMONARY-EMBOLISM IN A REFERRAL HOSPITAL

Objective: To determine the clinical characteristics of hospitalized p atients who died of pulmonary embolism, confirmed by evaluative autops y. Design: We retrospectively analyzed a series of autopsy cases of pu lmonary embolism at a tertiary-care center for the period Jan. 1, 1985 , through Dec. 31, 1989. Material and Methods: The medical and autopsy records of all hospitalized patients with autopsy proven fatal pulmon ary embolism mere reviewed. Cases of tumor emboli, fat emboli, and con tributory-only thromboembolic disease mere excluded from the study. Sp ecific symptoms and signs, diagnostic studies, and prophylactic measur es were noted. Results: Among 2,427 autopsies performed during the 5-y ear study period, death in 92 (3.8%) was clinically and pathologically judged to be caused by pulmonary embolism. No risk factors were noted in only 11 patients (12%). Prophylaxis against thromboembolism was us ed in 46%. Classic symptoms were often absent: dyspnea was present in only 59%, chest pain in only 17%, and hemoptysis in 3%. Pulmonary embo lism was considered in 49% of the 92 patients and was correctly assign ed as the cause of death on the death certificate or in the medical re cords in 32%. Testing for venous thromboembolic disease was performed in 22%. Comorbidity was present in most patients: 54% had guarded or p oor prognoses independent of pulmonary embolism. Conclusion: The usual signs and symptoms associated with pulmonary embolism did not adequat ely identify most of our patients who died of pulmonary embolism. The reasons included the absence of these signs and symptoms, inability to communicate (for example, sedated or comatose patient), sudden death from acute massive pulmonary embolism, and presence of comorbid factor s.