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A Retrospective Clinical Analysis of Pulmonary Embolism First-visit Data

Author: LiangZhenYu
Tutor: CaiShaoZuo
School: Southern Medical University,
Course: Pulmonology
Keywords: Pulmonary embolism Clinical features Clinical score First diagnosis Missed Misdiagnosis Age
CLC: R563.5
Type: Master's thesis
Year: 2009
Downloads: 146
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Abstract

1 Background and research purposes pulmonary embolism (PE) based on a variety of pulmonary emboli blocking system causes a group of diseases or clinical syndromes in general. PE more types of risk factors, some risk factors are more hidden, or even no clear risk factors; while the PE clinical presentation and chest X-ray, ECG and other routine laboratory examinations often lack specificity. However, these first-hand information on PE clinical in front of the first doctor, be the first diagnosis of PE and what impact? Information on why these first diagnosed first diagnosis of PE have such effects? Also, elderly (≥ 40 years of age ) as a risk factor for PE, previous studies have shown that elderly people diagnosed with PE harder; Well, young people and old people first diagnosis of PE data What are the different? What we can gain enlightenment? present study was designed to retrospectively analysis of 63 cases of first diagnosis of PE clinical data in order to answer these questions, raise awareness and efficiency of diagnosis of PE. 2 objects and methods 2.1 Object January 2001 - April 2008 in Guangzhou Nanfang Hospital, the hospital diagnosed 63 patients with PE. 2.2 PE inclusion and exclusion criteria of the diagnostic criteria: by CT pulmonary angiography (CTPA), magnetic resonance pulmonary angiography (MRPA), radionuclide lung ventilation perfusion scan and selective pulmonary angiography, echocardiography, and at least one diagnosis. Inclusion criteria: (a) comply with the diagnostic criteria for PE cases; (2) cases with complete data. Exclusion criteria: (a) without the above-mentioned five kinds of ways and at least one of the confirmed cases; (2) cases were incomplete. 2.3 Methods missed the first part of the first diagnosis PE Causes and misdiagnosis analysis of selected cases divided by first diagnosed case of first diagnosis diagnosed group (A group, 23 cases) and missed the first diagnosis group (B group, 40 cases), compared two groups of risk factors in , first diagnosed symptoms, diagnosis time, clinical score (Wells score, revised Geneva score), chest (after the onset, before diagnosis), electrocardiogram (after the onset, before diagnosis). The first analysis of common diseases misdiagnosed misdiagnosis. The second part of the young and elderly people first diagnosis of PE comparative data were divided into two groups, namely the younger group (<40 years, 21 cases) and old age group (≥ 40 years old, 42 cases). Relatively young group and number of risk factors in the elderly group, diagnosis time, clinical score, the first diagnosis confirmed diagnosis time and clinical subgroup scores first diagnosed subgroup missed diagnosis time and clinical scores first diagnosis, etc. The difference between clinical data analysis both groups confirmed the relationship between time and the diagnosis rate. 2.4 Statistical results using SPSS13.0 statistical package for statistical analysis. Measurement data for normality tests, such as the sample with normal distribution were expressed as mean ± standard deviation (x ± SD) said that the groups were compared using t-test; If the sample does not meet the normal places M (Q_R) said that the group were compared using WilcoXon rank test. Count data with the number of cases (%) said that the groups were compared using χ ~ 2 test; such as data appear theoretical value <1, then using the Fisher exact test. Younger group and older age group analysis confirmed time survival analysis (Kaplan-Meier method) between the two groups with the Log-Rank test. P <0.05 was considered statistically significant. 3 results missed the first part of the first diagnosis PE Causes and misdiagnosis analysis (1) A group of patients with recent surgery, cancer, bedridden, PE history, DVT compared with group B. B combined and high blood pressure, smoking, diabetes, lower extremity A group of high varicose veins than in which the two groups in recent surgery was statistically significant difference (χ ~ 2 = 6.011, p = 0.014). (2) A group of patients first diagnosed DVT symptoms include symptoms (asymmetric leg swelling / pain) of the 13 patients (56.5%), than in group B (12 cases, 30.0%) was significantly higher, the difference between the two groups statistically significant (χ ~ 2 = 4.291, P = 0.038); other chest symptoms first diagnosis showed no significant difference. (3) B group Wells score, revised Geneva score [were 2.50 (5.00), 5.50 (4.75)] than in group A [were 6.00 (6.00), 12.00 (9.00)] was significantly lower, the difference was statistically significant ( Z values ??were -3.296, -3.187, P values ??were 0.001,0.001). (4) B group chest X-ray reports: \lung infection \case for the simple missed; \(5) A group of ECG is normal for the two cases (8.7%), B group, 18 cases (45%), the differences between the two groups was statistically significant (χ ~ 2 = 8.883, P = 0.003); performance Typical SIQ Ⅲ / T Ⅲ / Q Ⅲ T Ⅲ who, A group of five cases (21.7%), B group, 0 cases, the differences between the two groups was statistically significant (χ ~ 2 = 6.704, P = 0.010). ECG changes other two groups was not statistically significant differences. (6) Analysis of misdiagnosis of the disease: The most common misdiagnosis were: lung infections / pneumonia, 37.5% (15/40), coronary heart disease 12.5% ??(5/40), COPD exacerbations (AECOPD) 7.5% (3 / 40), bronchitis 5.0% (2/40), left ventricular failure 5.0% (2/40), pleurisy 2.5% (1/40), 2.5% shingles chest (1/40), 20.0% Others (8 / 40). Misdiagnosed diseases, clinical manifestations, laboratory examinations and PE have a greater similarity, first attending physician often failed to be carefully identified. The second part of the young and elderly people first diagnosis of PE Comparison of data (a) the young group and elderly group of patients first diagnosed misdiagnosis rate was 66.7% (14/21), 61.9% (26/42), the difference between the two not statistically significant (χ ~ 2 = 0.137, P = 0.711). (2) group and the elderly group of young first diagnosis symptoms, clinical scores were similar to the old combination and number of risk factors more than the younger group, the difference was statistically significant (Z = -2.387, P = 0.017). In the first patient diagnosed subgroup, younger patients with similar number of risk factors in elderly patients. In the first patient subgroup missed, the number of elderly patients with risk factors was significantly more than younger patients, the diagnosis was significantly longer than younger patients, the differences were statistically significant. (3) two times KM curve prompt diagnosis elderly harder than the young group of PE diagnosis (Log-Rank test χ ~ 2 = 3.585, P = 0.058), but the need to increase the sample size was observed. (4) the young group misdiagnosed disease with pneumonia based; elderly group except misdiagnosed pneumonia, but misdiagnosed as coronary heart disease, AECOPD are more common. 4 Conclusion The first part: PE first diagnosis missed mainly due to: first attending physician to PE secondary risk factors for occult vigilance is not high, the over-reliance on chest X-ray reports, electrocardiogram, and some lack of careful identification of clinical manifestations of patients with PE not typical. First attending physician awareness needs to be raised to PE. Part II: the young and old people's first visit similar clinical manifestations were first diagnosed easily missed. PE elderly people incorporate more risk factors are common symptoms are easily concealed cardiopulmonary underlying disease, after the first diagnosis of missed diagnosis more difficult.

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